Effectiveness of the Enjoy-Breastfeeding Mom App on Breastfeeding Knowledge, Attitudes, Self-Efficacy, and Infant Responsiveness Among Thai Adolescent Mothers: A Three-Arm Randomised Controlled Trial

Abstract

Adolescent mothers experience persistent barriers to optimal breastfeeding, while evidence on the effectiveness of digital breastfeeding interventions tailored to this population remains limited. This three-arm, multicentre randomised controlled trial evaluated the effectiveness of the Enjoy-Breastfeeding Mom smartphone application on breastfeeding-related knowledge, attitudes, breastfeeding self-efficacy and maternal knowledge of infant cues and responsiveness among Thai adolescent mothers. A total of 150 primigravida adolescent mothers aged 15–19 years were recruited from four tertiary hospitals across Thailand and randomly allocated to (1) antenatal-to-postpartum application use, (2) postpartum-only application use or (3) usual nursing care (50 per group). Outcomes were assessed at baseline (30–34 weeks' gestation), postpartum day 3, and 30 days postpartum. Data were analysed using repeated-measures analysis of variance following the intention-to-treat principle, in accordance with the CONSORT Statement for non-pharmacological randomised clinical trials. Breastfeeding knowledge and attitudes were higher in both intervention groups than in usual care, with larger effects observed in the postpartum application group for knowledge (mean difference = 1.87, 95% CI 1.13–2.61) and in the antenatal application group for attitudes (mean difference = 7.95, 95% CI 6.52–9.36). Breastfeeding self-efficacy increased over time across all groups, with no clear between-group differences. Knowledge of infant cues and responsiveness was modestly higher in the intervention groups than in usual care (antenatal: mean difference = 0.70, 95% CI 0.21–1.19; postpartum: mean difference = 0.62, 95% CI 0.13–1.11). The Enjoy-Breastfeeding Mom application effectively improved breastfeeding knowledge and attitudes among Thai adolescent mothers. Adolescent-tailored digital interventions may enhance breastfeeding education and maternal learning when integrated with routine nursing care. Trial Registration:Thai Clinical Trials Registry (TCTR20240918007). Registered 18/09/2024.