Easyfeed: A Persuasive Breastfeeding Application for Nigerian Women

Abstract

Persuasive Technologies (PTs) are widely used as applications for promoting healthy behavior changes. They are applied in and tailored to many domains, including maternity and childcare. PTs incorporate different strategies capable of promoting this behavior change, including self-monitoring. Most current breastfeeding applications focus on Western culture, with little consideration for the cultural nuances and unique experiences of Nigerian breastfeeding mothers. Thus, this thesis seeks to address this gap by developing a breastfeeding application that is culturally relevant and tailored to the Nigerian community.

We present the design, development, and evaluation of the Easyfeed application, a mobile health (mHealth) application for promoting breastfeeding practices among Nigerian mothers. Through exploratory research, combining user-centered design (UCD) and persuasive systems design approaches, we designed the application and conducted a two-phase study (Easyfeed Phase 1 and Easyfeed Phase 2) to evaluate: the effectiveness of different persuasive strategies employed, usability, impact on breastfeeding mothers' motivation, attitudes, self-efficacy, and Nigerian mothers’ health belief inclinations. Prior to Phase 1, we identified three design goals (DG) from reviewing gaps in existing literature on mHealth applications for breastfeeding mothers: DG1 – Enhancing cultural relevance through shared design for Nigerian mothers and the inclusion of cultural music, DG2 – Implementing evidence-based persuasive strategies to encourage continued breastfeeding, and DG3 – Incorporating breast milk pumping to motivate breastfeeding.

In Phase 1, we developed a medium-fidelity prototype of the Easyfeed application addressing DGs 1-3 while incorporating three persuasive strategies (self-monitoring, reminder, and reward), that were selected based on existing applications, aligning with our design goals. We surveyed 154 participants to gather feedback on the prototype's usability, effectiveness, motivation to breastfeed, and its cultural relevance. The results from this survey helped to identify areas for improvement and informed the next phase of development, ensuring that the application was more tailored to users' needs and preferences. Subsequently, we invited our participants to take part in a voluntary interview session where 14 Nigerian women were interviewed to understand their overall perceptions about the application. Our analysis revealed several features that needed to be refined for Easyfeed Phase 2, including music and journaling.

Finally, in Phase 2, we refined the Easyfeed application based on feedback from Phase 1 and developed a high-fidelity prototype, incorporating additional persuasive strategies (competition and emotional appeal). The Phase 2 evaluation (N = 75) in the wild for 10 days, followed by an optional one-on-one interview with 15 participants, showed that the Easyfeed application was perceived as highly motivational, persuasive, useful, and supportive of their breastfeeding journey.