PUBLICATIONS


The theory-based design and development of a socially connected, gamified mobile app for men about breastfeeding

B. White, A Martin, J. White, S. Burns, B. Maycock, R. Giglia, J. Scott
JMIR mHealth and uHealth, June 2016
Available online here.

Abstract:
Background
Despite evidence of the benefits of breastfeeding, <15% of Australian babies are exclusively breastfed to the recommended 6 months. The support of the father is one of the most important factors in breastfeeding success, and targeting breastfeeding interventions to the father has been a successful strategy in previous research. Mobile technology offers unique opportunities to engage and reach populations to enhance health literacy and healthy behavior.

Objective
The objective of our study was to use previous research, formative evaluation, and behavior change theory to develop the first evidence-based breastfeeding app targeted at men. We designed the app to provide men with social support and information aiming to increase the support men can offer their breastfeeding partners.
Methods: We used social cognitive theory to design and develop the Milk Man app through stages of formative research, testing, and iteration. We held focus groups with new and expectant fathers (n=18), as well as health professionals (n=16), and used qualitative data to inform the design and development of the app. We tested a prototype with fathers (n=4) via a think-aloud study and the completion of the Mobile Application Rating Scale (MARS).

Results
Fathers and health professionals provided input through the focus groups that informed the app development. The think-aloud walkthroughs identified 6 areas of functionality and usability to be addressed, including the addition of a tutorial, increased size of text and icons, and greater personalization. Testers rated the app highly, and the average MARS score for the app was 4.3 out of 5.

Conclusions
To our knowledge, Milk Man is the first breastfeeding app targeted specifically at men. The development of Milk Man followed a best practice approach, including the involvement of a multidisciplinary team and grounding in behavior change theory. It tested well with end users during development. Milk Man is currently being trialed as part of the Parent Infant Feeding Initiative.

Keywords:
Breastfeeding, mobile technology, fathers, social support, gamification, engagement strategies

A multi-disciplinary partnership approach results in a successful mobile application for breastfeeding mothers

B. White, J. White, R. Giglia, S. Tawia
Health Promotion Journal of Australia (2016)
Available online here.

Abstract:
Issue addressed
Mobile applications are increasingly being used in health promotion initiatives. Although there is evidence that developing these mobile health applications in multidisciplinary teams is good practice, there is a gap in the literature with respect to evaluation of the process of this partnership model and how best to disseminate the application into the community. The aim of this paper is twofold, to describe the partnership model in which the Feed Safe application was developed and to investigate what worked in terms of dissemination.

Methods
The process of working in partnership was measured using the VicHealth partnership analysis tool for health promotion. The dissemination strategy and reach of the application was measured using both automated analytics data and estimates of community-initiated promotion.

Results
The combined average score from the partnership analysis tool was 138 out of a possible 175. A multipronged dissemination strategy led to good uptake of the application among Australian women.

Conclusions
Multidisciplinary partnership models are important in the development of health promotion mobile applications. Recognising and utilising the skills of each partner organisation can help expand the reach of mobile health applications into the Australian population and aid in good uptake of health promotion resources.

Keywords:
Dissemination strategies, evaluation methods, information and communication technology, mhealth

A study to prolong breastfeeding duration: design and rationale of the Parent Infant Feeding Initiative (PIFI) randomised controlled trial

B. Maycock, J. Scott, Y Hauck, S. Burns, S. Robinson, R. Giglia, A. Jorgensen, B. White, A. Harries, S. Dhaliwal, P. Howat, C. Binns
BMC Pregnancy Childbirth (2015)
DOI: 10.1186/s12884-015-0601-5
Available online here.

Abstract:
Background
Very few Australian infants are exclusively breastfed to 6 months as recommended by the World Health Organization. There is strong empirical evidence that fathers have a major impact on their partner’s decision to breastfeed and continuation of breastfeeding. Fathers want to participate in the breastfeeding decision making process and to know how they can support their partner to achieve their breastfeeding goals. The aim of the Parent Infant Feeding Initiative (PIFI) is to evaluate the effect on duration of any and exclusive breastfeeding of three breastfeeding promotion interventions of differing intensity and duration, targeted at couples but channelled through the male partner. The study will also undertake a cost-effectiveness evaluation of the interventions.

Methods/design
The PIFI study is a factorial randomised controlled trial. Participants will be mothers and their male partners attending antenatal classes at selected public and private hospitals with maternity departments in Perth, Western Australia. Fathers will be randomly allocated to either the usual care control group (CG), one of two medium intensity (MI1 and MI2) interventions, or a high intensity (HI) intervention. MI1 will include a specialised antenatal breastfeeding education session for fathers with supporting print materials. MI2 will involve the delivery of an antenatal and postnatal social support intervention delivered via a smartphone application and HI will include both the specialised antenatal class and the social support intervention. Outcome data will be collected from couples at baseline and at six and 26 weeks postnatally. A total of 1600 couples will be recruited. This takes into account a 25 % attrition rate, and will detect at least a 10 % difference in the proportion of mothers breastfeeding between any two of the groups at 26 weeks at 80 % power and 5 % level of significance, using a Log-rank survival test. Multivariable survival and logistic regression analyses will be used to assess the effect of the treatment groups on the outcomes after adjusting for covariates.

Discussion
The PIFI study will be the first Australian study to provide Level II evidence of the impact on breastfeeding duration of a comprehensive, multi-level, male-partner-focused breastfeeding intervention. Unique features of the intervention include its large sample size, delivery of two of the interventions by mobile device technology, a rigorous assessment of intervention fidelity and a cost-effectiveness evaluation.

Keywords:
Breastfeeding, mobile technology, fathers, evaluation, protocols

Harnessing information technology to innovate in primary care

M. Jiwa, A. McManus, A. Dadich, J. White, A. Rieck, S. Razmi
Quality in Primary Care, Feb 2013
Available online here.

Abstract:
The health sector’s capacity to meet the changing needs of patients is being questioned. This has significant implications for patients, carers, health services, and those who hold the public purse. It is therefore important to bolster its capacity to serve a greater proportion of people in need of healthcare, opportunities for which might be facilitated by information technology.

Aim
Identify strategies to bolster the capacity of the primary care sector to deploy and innovate with IT.

Methods
Three discussion groups comprising clinicians, regulatory agents, innovators, and academics from each Australian state. Themes discussed included: (1) health problems that can be readily solved by IT; (2) clinician engagement with IT; (3) experiences with IT implementation; (4) engagement with hard-to-reach groups; and (5) social media use.

Results
Although participants were aware of the issues surrounding the use of IT, including limited evidence and reduced data integrity, they were equally aware of the opportunities afforded by IT. With appropriate support, they indicated that IT could help to innovate and reinvigorate the primary care sector. This could be demonstrated via research, initiatives that improve governance arrangements (within and beyond the primary care sector), programs that enhance care delivery, and consumer empowerment initiatives.

Conclusion
Clinicians are rarely included as part of teams developing innovations, and technology is not always tailored for clinical practice or tested on clinical outcomes. Technical and access issues continue to hamper dissemination of innovation. The need for leadership in developing IT healthcare solutions remains paramount, with the organisation best able to negotiate with the key stakeholders at the helm.

Keywords:
Primary care, health innovation, social media, complex interventions, knowledge translation

Going native (or not): Five questions to ask mobile application developers

J. White
Australasian Medical Journal, Jan 2013, 6, 1, 7-14
Available online here

Abstract:
As the healthcare industry becomes increasingly aware of the opportunities and benefits of information technology, more and more service providers are being faced with the difficult task of commissioning development work and making sense of different approaches and estimates. This editorial piece presents practical advice, focusing on the core characteristics of mobile software and different approaches to development.

Keywords:
Application development, information communication technology, software, health innovation, service contracting

Fishing with the ‘net: A case for an electronic intervention to increase seafood consumption.

J. White
Australasian Medical Journal. 2011; 4(12):814-819
doi: 10.4066/AMJ.2011.1158
Available online here.

Abstract:
There is good evidence that regular fish consumption can lead to a range of health benefits, and that there is high public awareness of this fact. In spite of this, Australians do not, on average, consume fish to recommended levels. An intervention is proposed, leveraging social media and mobile technology. This approach is justified on the basis of a precedence of similar initiatives and the calculation of a potential target group size of 2.8 million adult Australians.

Keywords:
Brief health interventions, chronic disease, fish, seafood, social media, mobile technology

Health benefits of seafood for men

A. McManus, L. Fielder, W. Newton, J. White
Journal of Men's Health. 2011; 8(4):252-257
Available online here.

Abstract:
Background
Evidence supports the idea that the regular consumption of Omega-3 polyunsaturated fatty acids (Omega 3s) has positive effects on men's health. The best source of these essential fatty acids is seafood, particularly oily fish. This article summarises evidence pertaining to the benefits associated with regular dietary intake of fish on men's health.

Methods
An extensive review of international academic libraries, databases and published literature was conducted. Quality assessment ratings were applied and thematic classifications based on major health issues relevant to men were constructed.

Results
A total of 168 articles from peer-reviewed journals were identified, with 60 studies providing moderate to high level evidence of an association between the consumption of Omega 3s and health benefits for men. The majority of the studies showed a positive link between the intake of Omega 3s and the prevention and management of chronic disease in men. Evidence also showed a reduced risk of prostate cancer and lower lung cancer mortality in men who consumed high seafood diets.

Conclusion
There is conclusive evidence of an association between the dietary intake of Omega 3s and health benefits for men. However, men are less likely to consume fish as a main protein source, often tending towards diets high in red meat. Health promotion interventions should consider: the attitudes of men toward food and the impact of these attitudes on food choices; men's perceptions of fish and seafood, particularly in comparison to other protein sources; and the role that particular foods play for males in traditional social situations.

Keywords:
Men's health, PUFAs, preventive health, seafood

CONFERENCE PRESENTATIONS


Using mobile devices (mhealth) for dietary interventions in pregnancy and early childhood (workshop)

J. Scott, B. White
Dietitians Association of Australia Conference
Melbourne, Australia
May 2016

Keywords:
mHealth, mobile technology, nutiriton, early childhood, interventions

Pier 2 Peer: Development and evaluation of a mobile application to increase fish consumption

J. White, A. McManus, M. Jiwa
Medicine 2.0: World Congress on Social Media, Mobile Apps, Internet/Web 2.0 (Malaga, Spain)
October 2014

Abstract:
Background: Fish consumption is well documented as being protective against several chronic diseases, yet many people do not eat it sufficiently to achieve health benefits. Many people cite a lack of confidence in finding, selecting and cooking fish in ways that are acceptable to their families, while regular consumers appear to possess such confidence. Socially-connected mobile apps create an opportunity to facilitate knowledge sharing, and potentially increase healthy behaviours, including regular fish consumption.

Objective: To determine whether a socially-connected mobile application can be effective in promoting health behaviour change, and whether this effect can be empirically proven using data collected via the application itself.

Methods: The study was based on a framework for developing and evaluating complex interventions, proposed by the UK Medical Research Council. Further theoretical guidance was taken from the Behavioural Perspective Model (BPM), a consumer behaviour model based on the concepts of consumer learning history and purchase settings. The study comprised three phases.

Phase 1- Formative research: A literature review examined trends and themes in fish consumption behaviour, and previous examples of successful social media/electronic health interventions. Seven focus groups were conducted (n = 36) to further explore themes from the review. Questions were based on BPM categories, such as learning history, hedonic and informational reinforcements and punishers. Major themes were identified, compared and contrasted with themes from literature. Recommendations were outlined for application development.

Phase 2 - Application development: A mobile application, called Pier2Peer, was designed and developed to specifically address the main barriers to consumption identified in the formative research. The app presented information for more than 200 Australian commercial fish species. It facilitated the sharing of information between users, including how to use various species, cooking tips, and the best places to source high quality fish. It enabled users to track their fish consumption, giving health feedback including omega-3 intake.

Phase 3 - Application evaluation: A three-month controlled pilot study (test n = 50, control n = 50) will be conducted, where test participants have access to all features of the application and record their fish consumption in an in-app diary, while control group participants only record consumption. Fish consumption will be validated by taking and submitting a photo of the meal, facilitated within the app. Use of the app will be exhaustively documented, including fish consumption (amount, type, cooking method), time spent using the app, features used most often, variation between actual consumption time and reporting, and contributions to social functions of the app. Fish consumption data will be analysed, looking for significant variation between test and control groups. Further analysis will be made of correlations between different app use patterns and consumption changes, to better understand the most/least effective aspects of the application. Conclusions and recommendations will be made for the development and evaluation of mobile apps with a focus on promoting healthy behaviour.

Keywords:
Health innovation, complex interventions, mobile applications, fish, seafood

Feed Safe: Development, evaluation and promotion of a mobile app to assist breastfeeding mothers to make safe decisions about alcohol consumption

J. White, B. White, R. Giglia
Medicine 2.0: World Congress on Social Media, Mobile Apps, Internet/Web 2.0 (Malaga, Spain)
October 2014

Abstract:
Background: In Australia, breastfeeding mothers are officially advised that the safest practice is to abstain from alcohol. However, the National Health and Medical Research Council (NHMRC) acknowledges that the abstinence message may discourage breastfeeding, and supports the provision of practical guidance regarding minimising the risk to lactation and to the breastfed infant, for mothers who choose to drink. In practical terms, women are advised to consume no alcohol for the first month, then to limit their drinking to no more than two standard drinks per day, and to time their consumption to minimise impact.
In 2001 researchers at the Canadian Motherisk program developed a nomogram which used a mother’s height, weight and alcohol consumed to calculate the time to zero level in breastmilk. This was adapted for use in Australia by Dr Roslyn Giglia and the Australian Breastfeeding Association (ABA), and included in a brochure containing guidelines and other information. This work was later incorporated into the NHMRC public guidelines.

Development and evaluation of the Feed Safe app: The Feed Safe app was developed to make this information more readily accessible, and to allow more accurate, personalised timing calculations. A partnership-focussed model was used, with support and input in the development, evaluation and dissemination phases, by Dr. Giglia, the ABA, and West Australian services providers. The app was tested and evaluated by community members, and a number of changes were made in response to feedback, before the app was publicly released. The project received funding from Healthway, the West Australian Health Promotion Foundation.
Feed Safe is a native app for iOS devices. Native development was chosen over other cross-platform options, to achieve a high level of quality and usability, and also to ensure offline-usability and data security (information entered by users remains on the device, and is not transmitted to any server). A native Android version is under discussion at the time of writing. A high priority was placed on design, clarity and ease of use, and post-launch feedback has suggested these goals were largely achieved.

Promotion: A two-pronged promotional campaign targeted both traditional and social media. Media releases were sent to major news organisations, resulting in a number of radio interviews and a prominent article in the major West Australian newspaper. Social media discussion saw significant interest in the app during its first week of availability, with a single ABA Facebook post being shared more than 400 times. In a single week, the Feed Safe website received more than 6000 page views, with the app being downloaded nearly 3000 times. The app spent several days as the second most downloaded free health and fitness app on the Australian App Store and at the time of writing continues to receive around 100 downloads per day.

Discussion: The Feed Safe project is a good example of an effective multi-disciplinary partnership resulting in a tool that was well received by users. An effective publicity campaign led to high uptake and good value for money for the project funders.

Keywords:
Breastfeeding, alcohol, health innovation, mobile applications, partnership models,

Smartphone technology brings alcohol and breastfeeding into the mainstream

R. Giglia, C. Binns, B. White
Community Health Nurses WA Conference
Perth, Australia
August 2014

Keywords:
Breastfeeding, mobile technology, alcohol

Working together towards healthy communities

B. White, T. Tinworth, M. Orifici
WA Health Conference
Perth, Australia
2011

Keywords:
Health promotion, capacity building, local government, partnership working