A formative study to inform mHealth based randomized controlled trial intervention to promote exclusive breastfeeding practices in Myanmar: incorporating qualitative study findings

Background: Undernutrition is a major concern for Myanmar children with low exclusive breastfeeding rate (24%). A formative study was conducted to explore the perceptions and practices relating to exclusive breastfeeding, and barriers and facilitators to using mobile communications for exclusive breastfeeding counselling. The results inform the design of a randomized control trial to promote exclusive breastfeeding practices among Myanmar mothers. Methods: We conducted twenty in-depth interviews with pregnant women and accompanying family members attending an antenatal clinic at the Central Women's Hospital, Yangon, seven key-informant interviews and one focus group discussion with fifteen service providers such as nurses, doctors, managers and staff from the National Nutrition Centre, Department of Health, United Nations Children's Fund International and National Non-Government Organizations and Ooredoo, a private mobile company. Results: Widespread practices of feeding water, honey, infant formula and semi-solid food were reported to be existed in the community before the child reaches four months, mostly influenced by grandmothers from both sides. All couples knew breast milk was good for baby and intended to breastfeed, though limited understanding of the term exclusive breastfeeding was reported. Perception that breast milk alone was not sufficient to provide all nutrients needed for the first six months of baby's life, mother had insufficient milk supply or breast problems, mother's back to work and grandmothers' influence emerged as barriers to breastfeed exclusively for six months. All women knew how to make basic phone calls, majority could read mobile text message in Burmese and possess mobile phones while a few of them shared phones with their husbands. All couples preferred to receive text messages 2-3 times per week in the evening. Institutional staff suggested messages to be simple, easily understandable and culturally appropriate. Perceived barriers included limited mobile network coverage, affordability of mobile handset and phone bills, literacy and community familiarity with text messages. All respondents welcomed the idea of planned intervention. Conclusion: We incorporated findings to develop messages and determine the modality, inclusion criteria and tailored with gestation and child age, to be delivered in the randomized controlled trial intervention.