Expanding Rural Access to Breastfeeding Support via Telehealth: A Pilot Randomized Controlled Trial
Grantee: Rand Corporation, The
Principal Investigator: Lori Pines
Project Number: R40MC29451
Project Date: 04/01/2016
Age group(s)
- Perinatal/Infancy (0-12 months)
- Women/Maternal
Abstract
Increasing breastfeeding rates is an ongoing public health priority because of the health and economic benefits for infants, mothers, and communities. Professional lactation support, specifically by International Board Certified Lactation Consultants (IBCLCs), increases breastfeeding duration and exclusivity. Rural and underserved mothers have lower breastfeeding rates, and limited access to professional lactation support may contribute to this disparity. As such, the Surgeon General identifies increasing access to IBCLCs as a policy priority. Virtual "telelactation" consults that use two-way video have the potential to increase access to IBCLC services in rural settings that lack them. Several companies have begun to offer telelactation through a direct-to-consumer (DTC) model, where patients initiate video calls with providers using their personal devices including mobile phones, tablets, and laptops. In 2015, Doctor on Demand, one of the largest telehealth companies, began to offer DTC telelactation services with IBCLCs. While four studies with small samples explored the use of antiquated videoconferencing technology (i.e., that required dedicated equipment) for lactation support, no research has studied DTC telelactation or linked telelactation with breastfeeding outcomes.To address this evidence gap, we will conduct a randomized controlled trial (RCT) to generate data on the impact of DTC telelactation services. Postpartum mothers age 18 and older who have initiated breastfeeding will be recruited at a critical access hospital without access to IBCLCs in rural Pennsylvania and randomized into two study arms: 1) outpatient telelactation services via video calls on personal devices or 2) usual care. Data on breastfeeding duration and exclusivity, as well as perceptions and satisfaction with breastfeeding, will be captured via surveys and in-depth interviews and compared across groups. To our knowledge, this study will be the first experimental evaluation of telelactation and the first ever evaluation of DTC telelactation services. It directly addresses MCHB Strategic Research Issues including promoting the healthy development of Maternal Child Health (MCH) populations (IV) and efforts to eliminate health disparities and barriers to access for MCH populations (II). This project leverages our prior work on using technology to support breastfeeding interventions and the impact of DTC telehealth on access and quality. The results will inform policy debates about reimbursement and regulation of DTC telehealth services and the strengths and limitations of this model of healthcare delivery as applied to breastfeeding. It also has the potential to promote breastfeeding, one of the most widely recommended health behaviors among underserved families, and improve children's health in rural settings.Publications
Listed is descending order by year published.
Uscher-Pines L, Mehrotra A, Gogen DL. The emergence and promise of telelactation. Am J Obstet Gynecol 2017 Aug;217(2):176-178.e1.
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