Breastfeeding Education Preferences of Pregnant People with Low Incomes

Author

• Megan KindredFollow

Date of Award

Spring 5-2026

Degree Name

Doctor of Philosophy in Nursing (PhD)

Advisor(s)

Cathy L. Rozmus, PhD

Second Advisor

Constance Johnson, PhD

Third Advisor

Pamela Berens, M.D.

Fourth Advisor

Thomas F. Northrup, PhD

Abstract

Background: The proportion of infants breastfed at 1 year in the United States remains below the Healthy People 2030 goal. Longer breastfeeding durations are important due to dose-response benefits, but disparities are greater among those with low incomes. Prenatal breastfeeding education (PBE) interventions can increase breastfeeding duration. Additionally, incentivization and gamification can be used to increase use of educational technology but are underexplored in this domain. Prior studies examining PBE format preferences do not reflect currently available technology. PBE format preferences of childbearing people should be reexamined.

Purpose: This purpose of this study is to: (1) identify PBE format preference of pregnant people with low incomes, (2) determine if these preferences vary by age (3) or by weekly hours worked, and (4) determine participant-reported future likelihood of using a smartphone game app to learn about breastfeeding while exploring variation by age, employment, or incentivization.

Methods: A cross-sectional online survey, informed by a focus group and interviews, explored PBE preferences of pregnant people with low incomes. Descriptive and bivariate statistics described preferences and identified differences by age and weekly hours worked. Multivariable linear regression evaluated the likelihood of using a game app to learn about breastfeeding.

Results: The most-preferred PBE formats, in order of preference, were TikTok videos, one-on-one sessions with a WIC breastfeeding peer counselor, online courses, books, and YouTube videos. Younger respondents were less likely to have any breastfeeding education and more likely to report using TikTok for breastfeeding information. Millennials were more than twice as likely to attend an in-person class as their younger peers. A multivariable linear regression model examining age found that age was significantly associated with self-reported future likelihood of using an incentivized game app to learn about breastfeeding (F(22, 326) = 1.611, p = .042), explaining 9.8% of the variation in likelihood of use (R² = .098). A similar model found weekly hours worked to be significantly associated with reported likelihood of using an incentivized game app to learn about breastfeeding (F(15, 461) = 2.30, p = .004), explaining 7% of the variation in self-reported future likelihood of use (R² = .070).

Recommended Citation

Kindred, Megan, "Breastfeeding Education Preferences of Pregnant People with Low Incomes" (2026). Dissertations and Theses (Open Access). 74.
https://digitalcommons.library.tmc.edu/uthson_etd/74

Keywords

breastfeeding, lactation, prenatal education, pregnancy