The coronavirus disease 2019 (COVID-19) pandemic evinced the critical role of information and communication technologies in the different spheres of life.1 Digital tools were essential in ameliorating the deleterious impact of the health crisis caused by the pandemic and allowing access to various health care services, including breastfeeding (BF) support.
The increase in the past few years in the use of mobile devices and the online access capabilities of these devices have given rise to an important mobile health application (app) market. According to The State of Mobile in 2022 report of the App Annie mobile data and analytics platform,2 in 2021, there were 230 000 new app downloads, with a 5% increase compared to 2020, with global consumers downloading an average of 435 000 apps per minute.
In 2018, we conducted a descriptive study of the BF apps available online, which was published in this journal.3 Four years after the initial study, on the other side of the pandemic, we undertook another study with the aim of analysing the evolution of BF apps, the number of downloads and the contents of these apps to assess their usefulness as health care tools for BF promotion in circumstances in which it was not possible to provide lactating women in-person services at health care facilities.
We carried out a mixed-methods study, searching the main app marketplaces using the search term “lactancia materna” (breastfeeding), applying the following inclusion criteria: Spanish language and availability through 31/12/2021.
Then, we classified the apps based on the following variables: operating system, developer, type, country of origin, target population, indications or purposes of the app, feedback (possibility to interact with the platform) and whether the app was free or paid.
Last of all, we made a qualitative analysis of the content of the app for the “indication” variable based on the description of the developer of the app, creating 3 subcategories for a more detailed analysis of the app content: information, tracking and other BF content (books/magazines, entertainment [games], events, maps [BF resources, professionals, leisure], professional websites and BF support associations) (Table 1).
Descriptive analysis of breastfeeding apps in Spanish, 2009-2021 period.
| n | % | |
|---|---|---|
| Operating system | ||
| iOS | 69 | 32.39 |
| Android | 143 | 67.14 |
| Windows | 1 | 0.47 |
| Creator/developer | ||
| Non-professional (mothers, software companies, other) | 185 | 86.85 |
| Professional | 28 | 13.15 |
| Physician/paediatrician/nurse | 12 | 5.63 |
| Professional association | 6 | 2.82 |
| Medical student | 4 | 1.88 |
| Lactation consultants (IBCLC) | 6 | 2.82 |
| Region where app was developed | ||
| Europe | 123 | 57.74 |
| Spain | 75 | 35.21 |
| North America | 40 | 18.78 |
| South America | 29 | 13.62 |
| Asia | 20 | 9.39 |
| Oceania | 1 | 0.47 |
| Target population | ||
| Mothers/fathers | 100 | 46.95 |
| Mothers | 76 | 35.68 |
| Parents/professionals/support groups/caregivers | 24 | 11.27 |
| Professionals | 10 | 4.69 |
| Minors aged >12 years | 3 | 1.41 |
| Purposes of the app (analysis categories) | ||
| Facilitate tracking of: | 93 | 43.66 |
| Breastfeeding | 59 | 27.70 |
| Infant habits | 73 | 34.27 |
| Infant development | 59 | 27.70 |
| Other | 46 | 21.60 |
| Utility software | 36 | 16.90 |
| Breastfeeding and formula feeding | 63 | 29.58 |
| Complementary feeding | 45 | 21.13 |
| Provide information on: | 90 | 42.25 |
| Breastfeeding | 51 | 23.94 |
| Infant development | 40 | 18.78 |
| Other | 37 | 17.37 |
| Complementary feeding | 25 | 11.74 |
| Care of mother | 34 | 15.96 |
| Breastfeeding and formula feeding | 13 | 6.10 |
| Other BF content: | 17 | 7.98 |
| Books/magazines | 8 | 3.76 |
| Entertainment (Games) | 7 | 3.29 |
| Events | 4 | 1.88 |
| Resource maps (breastfeeding, professionals, leisure) | 6 | 2.82 |
| Professional websites | 1 | 0.47 |
| Breastfeeding organizations | 1 | 0.47 |
| Information and monitoring | 13 | 6.10 |
| Feedback | 43 | 20.19 |
| Free app | 190 | 89.20 |
The search yielded 340 apps, of which 213 met the inclusion criteria. The main findings were that in the past few years, the development of BF apps has doubled and the mean number of downloads of these apps, overall, was 231 812, triple compared to the initial study. Another interesting finding was the increase in the proportion with professional developers, from 3.4% to 13.15%. Fig. 1 presents the growth in terms of new launches (number of apps per year), in which we can discern a growing trend since 2019.
Most of the apps were designed for parents (46.95%). A majority were free (89.90%), and the mean price of paid apps increased to 11.65. In terms of the purpose of the app, the majority were apps for tracking BF (43.66%), followed by apps with BF information (42.25%) and other types of BF content (7.98%). When it came to feedback, the proportion of apps for which it was available increased from 14.40% to 20.19%, which could be due to the need for social interaction elicited by lockdown measures and the exponential growth of our online lives.
The restricted access to in-person health care services on account of COVID-19 brought on an increase in telemedicine services4 and downloads of digital content or software related to BF, as described in the breastfeeding report for year 2020 published by the LactApp team.5 However, the recommendation of these apps by health care professionals is limited and growing slowly, and requires generating a shared knowledge base to guarantee the safety of users, chiefly due to the current lack of evaluation and accreditation.6 This poses a challenge to professionals, as we need to find out the sources of the content offered by apps, which should be based on scientific evidence. In our study, we did not identify any apps with any form of certification guaranteeing their quality or safety.
In a world inexorably moving towards the increasing digitalization of all of its dimensions, the recommendation of mobile health apps should be supported by competent organizations so that professionals can feel confident in doing so. The fact that there is no list of mobile applications, guidelines for their use or accreditation system complicates it further.
We believe that the development and recommendation of apps for BF mothers by health care professionals is here to stay, and these apps could become another useful resource for BF promotion.
