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Use of an Interactive Computer Agent to Support Breastfeeding

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Abstract

Mothers need consistent, sustained information and support to develop and meet personal breastfeeding goals, but often receive insufficient assistance and conflicting and incorrect advice. The use of technology may be helpful in supplementing existing health care professional breastfeeding education and support efforts. We developed and evaluated a computer-based animated, interactive agent designed to provide breastfeeding information and support to mothers interested in breastfeeding. A randomized controlled study of a first-generation system was conducted to determine the feasibility of (1) use of the Computer Agent; (2) the recruitment plan; and (3) the planned outcome evaluation (assessing the impact of the intervention on intent to breastfeed, attitudes towards breastfeeding, and breastfeeding self-efficacy). The pilot study (N = 15) showed that the use of the Computer Agent, the recruitment plan, and the planned outcome evaluation were all feasible. Mothers who used the Computer Agent had greater intentions to exclusively breastfeed after exposure to the Agent (intent to exclusively breastfeed for 6 months 1–7 scale score of 6.14 (post) vs. 5.14 (pre); p < 0.05). Non-statistically significant trends in improvement with use of the Computer Agent breastfeeding support system were also seen in the between subjects analyses of intent to breastfeed and breastfeeding self-efficacy. The pilot study demonstrated the feasibility of using a Computer Agent to support breastfeeding mothers and informed the design of a larger randomized clinical trial. An interactive Computer Agent may be helpful in improving rates of exclusive breastfeeding, particularly when there is not adequate health care professional support.

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References

  1. Section on Breastfeeding. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827–e841.

    Article  Google Scholar 

  2. Centers for Disease Control and Prevention. (2009). Breastfeeding Among US Children Born 2000–2009, CDC National Immunization Survey. Available from: http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm. Accessed January 11, 2013.

  3. Declercq, E., et al. (2009). Hospital practices and women’s likelihood of fulfilling their intention to exclusively breastfeed. American Journal of Public Health, 99(5), 929–935.

    Article  PubMed  Google Scholar 

  4. U.S. Department of Health and Human Services, Office of the Surgeon General. (2011). The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: Available from: http://www.surgeongeneral.gov/library/calls/breastfeeding/calltoactiontosupportbreastfeeding.pdf. Accessed July 10, 2012.

  5. Cross-Barnet, C., et al. (2012). Long-term breastfeeding support: Failing mothers in need. Jan: Matern Child Health J. 15.

    Google Scholar 

  6. McInnes, R. J., & Chambers, J. A. (2008). Supporting breastfeeding mothers: Qualitative synthesis. Journal of Advanced Nursing, 62(4), 407–427.

    Article  PubMed  Google Scholar 

  7. Clinite, J., & Kabat, H. (1976). Improving patient compliance. Journal of the American Pharmacists Association, 16, 74–76.

    CAS  Google Scholar 

  8. Madden, E. (1973). Evaluation of outpatient pharmacy patient counseling. Journal of the American Pharmacists Association, 13, 437–443.

    Google Scholar 

  9. Morris, L., & Halperin, J. (1979). Effects of written drug information on patient knowledge and compliance: a literature review. American Journal of Public Health, 69, 47–52.

    Article  PubMed  CAS  Google Scholar 

  10. Qualls, C., Harris, J., & Rogers, W. (2002). Cognitive-Linguistic Aging: Considerations for Home Health Care Environments. In W. Rogers & A. Fisk (Eds.), Human factors interventions for the health care of older adults (pp. 47–67). Mahwah, NJ: Lawrence Erlbaum.

    Google Scholar 

  11. Frankel, R. (1995). Emotion and the physician-patient relationship. Motivation and Emotion, 19, 163–173.

    Article  Google Scholar 

  12. Richmond, V., McCroskey, J. (1995). Immediacy. In V. P. Richmond (Ed.), Nonverbal behavior in interpersonal relations (pp. 195–217). Boston: Allyn & Bacon.

  13. Doak, C., Doak, L., & Root, J. (1996). Teaching patients with low literacy skills (2nd ed.). Philadelphia, PA: JB Lippincott.

    Google Scholar 

  14. Clark, H. H., & Brennan, S. E. (1991). Grounding in Communication. In L. B. Resnick, J. M. Levine, & S. D. Teasley (Eds.), Perspectives on socially shared cognition (pp. 127–149). Washington: American Psychological Association.

    Chapter  Google Scholar 

  15. Davidoff, F. (1997). Time. Annals of Internal Medicine, 127, 483–485.

    Article  PubMed  CAS  Google Scholar 

  16. Hussainy, S. Y., & Dermele, N. (2011). Knowledge, attitudes and practices of health professionals and women towards medication use in breastfeeding: A review. International Breastfeeding Journal, 6, 11.

    Article  PubMed  Google Scholar 

  17. Bickmore, T., Gruber, A., & Picard, R. (2005). Establishing the computer-patient working alliance in automated health behavior change interventions. Patient Education and Counseling, 59, 21–30.

    Article  PubMed  Google Scholar 

  18. Bickmore, T., & Picard, R. (2005). Establishing and maintaining long-term human-computer relationships. ACM Transactions on Computer Human Interaction, 12, 293–327.

    Article  Google Scholar 

  19. Katz, M. G., et al. (2007). Patient literacy and question asking behavior during the medical encounter: A mixed-methods analysis. Journal of General Internal Medicine, 22(6), 782–786.

    Article  PubMed  Google Scholar 

  20. Bickmore, T. W., Pfeifer, L. M., & Paasche-Orlow, M. K. (2009). Using computer agents to explain medical documents to patients with low health literacy. Patient Education and Counseling, 75(3), 315–320.

    Article  PubMed  Google Scholar 

  21. Miller, W. R., & Roland, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: Guilford Press.

    Google Scholar 

  22. World Health Organization. (2004). Promoting proper feeding for infants and young children. Geneva. Available from: http://www.who.int/nutrition/topics/infantfeeding/en/. Accessed July 20, 2012.

  23. de la Mora, A., et al. (1999). The Iowa infant feeding attitude scale: Analysis of reliability and validity. Journal of Applied Sociology and Psychology, 29(11), 2362–2380.

    Article  Google Scholar 

  24. Dennis, C. L., & Faux, S. (1999). Development and psychometric testing of the Breastfeeding Self-Efficacy Scale. Research in Nursing Health, 22(5), 399–409.

    Article  PubMed  CAS  Google Scholar 

  25. Hollander, M., & Wolfe, D. A. (1973). Nonparametric statistical methods. New York: John Wiley & Sons.

    Google Scholar 

  26. R Development Core Team. (2011). R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing. ISBN 3-900051-07-0, URL http://www.R-project.org/.

  27. Agresti, A. (2002). Categorical data analysis (2nd ed.). New York: Wiley.

    Book  Google Scholar 

  28. Thabane, L., et al. (2010). A tutorial on pilot studies: The what, why and how. BioMed Central Medical Research Methodology, 10, 1.

    Article  PubMed  Google Scholar 

  29. Altman, D. G., & Bland, J. M. (1995). Absence of evidence is not evidence of absence. British Medical Journal, 311, 485.

    Article  PubMed  CAS  Google Scholar 

  30. Nommsen-Rivers, L. A., et al. (2010). Comfort with the idea of formula feeding helps explain ethnic disparity in breastfeeding intentions among first-time expectant mothers. Breastfeeding Medicine, 5(1), 25–33.

    Article  PubMed  Google Scholar 

  31. Pew Internet & American Life Surveys. (2012). http://pwerinternet.org. Accessed December 14, 2012.

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Acknowledgments

The authors gratefully acknowledge the seed grant funding that was received from the Bouvé College of Health Sciences, Northeastern University for this pilot study.

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Authors and Affiliations

  1. Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, 140 The Fenway Building, R218, Boston, MA, 02115, USA

    Roger A. Edwards & Justin Manjourides

  2. College of Computer and Information Science, Northeastern University, Boston, MA, USA

    Timothy Bickmore

  3. Melrose Wakefield Hospital, Hallmark Health, Melrose, MA, USA

    Lucia Jenkins & Mary Foley

Authors
  1. Roger A. Edwards
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  2. Timothy Bickmore
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  3. Lucia Jenkins
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  4. Mary Foley
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  5. Justin Manjourides
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Correspondence to Roger A. Edwards.

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Edwards, R.A., Bickmore, T., Jenkins, L. et al. Use of an Interactive Computer Agent to Support Breastfeeding. Matern Child Health J 17, 1961–1968 (2013). https://doi.org/10.1007/s10995-013-1222-0

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  • DOI: https://doi.org/10.1007/s10995-013-1222-0

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