#BlackBreastsMatter: Process evaluation of recruitment and engagement of pregnant African American women for a social media intervention study to increase breastfeeding

Cassy Dauphin, Nikia Clark, Renee Cadzow, Frances Saad-Harfouche, Elisa Rodriguez, Kathryn Glaser, Marc Kiviniemi, Maria Keller, Deborah Erwin

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: In the United States, there are lower rates of breastfeeding among African American mothers, particularly those who are younger women. Recent epidemiological studies have shown a strong association of more aggressive types of breast cancer (estrogen receptor negative) among African American women, with a higher risk in African American women who did not breastfeed their children. Objective: This study aims to describe the process evaluation of recruitment and educational strategies to engage pregnant African American participants for a pilot study designed to determine whether social media messaging about breast cancer risk reduction through breastfeeding may positively influence breastfeeding rates. Methods: This pilot study is conducted in collaboration with a local Women, Infants, and Children (WIC) organization and hospital and prenatal clinics of a local health care network. To engage African American women to enroll in the study, several methods and monitoring processes were explored, including WIC electronic text-based messages sent out to all phones of current WIC recipients (referred to as e-blasts); keyword responses to texts from flyers and posters in local community-based organizations, hospitals, and prenatal clinics; keyword responses using electronic links posted in established Facebook groups; and snowball recruitment of other pregnant women by current participants through Facebook. Once enrolled, participants were randomized to 2 study conditions: (1) an intervention group receiving messages about breast cancer risk reduction and breastfeeding or (2) a control group receiving breastfeeding-only messages. Data were obtained through electronic monitoring, SurveyMonkey, qualitative responses on Facebook, focus groups, and interviews. Results: More than 3000 text messages were sent and received through WIC e-blasts and keyword responses from flyers. A total of 472 women were recruited through WIC e-blast, and 161 responded to flyers and contacts through the local health care network, community-based organizations, Facebook, and friend referrals. A total of 633 women were assessed for eligibility to participate in the study. A total of 288 pregnant African American women were enrolled, consented, and completed presurvey assessments (102.8% of the goal), and 22 participants attended focus groups or interviews reporting on their experiences with Facebook and the educational messages. Conclusions: This process evaluation suggests that using electronic, smartphone apps with social media holds promise for both recruitment and conduct of health education intervention studies for pregnant African American women. Providing messaging and resources through social media to reinforce and educate women about breastfeeding and potentially provide lactation support is intriguing. Convenience (for researchers and participants) is an attribute of social media for this demographic of women and worthy of further research as an educational tool.

Original languageEnglish
Article numbere16239
JournalJournal of Medical Internet Research
Issue number8
StatePublished - Aug 2020

Bibliographical note

Funding Information:
This study was funded by the National Institutes of Health (NIH), National Cancer Institute (NCI) 1R21CA202263. The authors would like to acknowledge the support and collaboration from Katie Constantino and the Catholic Charities WIC program in Western New York; Kaleida Health System, Durham’s Baby Café in Buffalo, New York; Dr Ann Oluloro; and Dr Joseph Denagy. The authors also acknowledge support from the University of Kentucky, Lexington, Kentucky; D’Youville College, Buffalo, New York; and Roswell Park Comprehensive Cancer Center (NIH/NCI P30CA016056), Buffalo, New York.

Funding Information:
Unlike commercial Facebook pages, private pages were not eligible for tracking activities (eg, likes, comments) at the time this study was conducted; therefore, methods were limited to manual review of comments, responses, and questions. A manual data collection spreadsheet was initiated and monitored for 2 months but proved too time-consuming to continue with the limited staff supported by the pilot (NIH/NCI R21) grant funding. It was determined to be more important to engage and interact with the participants on Facebook, continuing regular posting of educational messages, and answering questions and comments.

Publisher Copyright:
© 2020 Journal of Medical Internet Research. All rights reserved.


  • African American mothers
  • Breast cancer education
  • Breastfeeding
  • Facebook
  • Mobile phone
  • Social media

ASJC Scopus subject areas

  • Health Informatics


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