Mothers with gestational diabetes mellitus and their babies have increased risks for diabetes, obesity, and cardiovascular complications [4, 5], and breastfeeding is reported to help lower these risks [10, 11]. However, due to various barriers, the rate of breastfeeding is low among mothers with gestational diabetes mellitus [12]. This study is significant because, in the current situation in which people adhere to social distancing due to COVID-19, a mobile application design was developed to help mothers with diabetes mellitus who are vulnerable to infection and have difficulty breastfeeding. As of May 2022, apps for breastfeeding and management of gestational diabetes mellitus were developed separately, and, thus, mothers with gestational diabetes mellitus must use at least two apps to obtain help with breastfeeding. The development of the BFGDM App allows mothers with the condition to use a single app, which increases accessibility and convenience.
To promote breastfeeding in mothers with diabetes mellitus, the application design was developed by referring to MASUN [15]. In addition, to improve the app’s usability, the app structure and UI were implemented based on the experiences and needs of four mothers with gestational diabetes mellitus and also on user needs derived by three researchers in women’s health nursing (two professors and a clinical instructor), who were not app developers, using the method specified in MASUN [25]. The methodology of involving end users of the to-be-developed app in the process of implementing the UI and creating a draft design before finalizing it has also been utilized in previous studies [17, 25].
The method of this study can be used by researchers who plan to create a mobile app UI for target users with a small number of study participants over a relatively short time [17]. The BFGDM App was developed to promote breastfeeding in mothers with gestational diabetes mellitus with focus on addressing their questions and difficulties and stimulating community activity to increase the motivation for breastfeeding by providing overall information regarding breastfeeding, how to breastfeed, a breastfeeding journal, breast management techniques, and breastfeeding questions and answers.
Despite delayed development of mammary glands and physical discomfort during labor [12], mothers with diabetes mellitus who breastfed stated that, with short-term suffering, they were able to reduce the feeling of guilt by providing their babies with the best nutrition. They enumerated specific knowledge and emotional support as success factors for breastfeeding [26]. This is consistent with a finding derived from the user needs survey conducted in this study, i.e., informational needs. To provide breastfeeding-specific information, the BFGDM App was designed to show the features of breastmilk for mothers with diabetes mellitus, advantages of breastfeeding to mothers with the condition, successful breastfeeding stories, breastfeeding methods, breast massage techniques, and breast problem management in the breastfeeding information screen. It is believed that this detailed information will help app users acquire the knowledge they need when breastfeeding their baby. In particular, videos demonstrating breastfeeding and breast management methods were included in the app to help users learn the techniques easily. Additionally, the app was designed to make it easy for users to acquire specialized knowledge and learn how to manage breast problems immediately by providing contact information of breast management education centers.
The data screen consisted of recordings about breastfeeding sessions and baby growth. The design components were created by combining the findings derived from the user needs survey and the functions of existing parenting apps (Babytime: over 1 million downloads, a star rating of 4.9; Parenting Diary: over 500,000 downloads, a star rating of 4.8). The components are expected to be helpful to app users in monitoring the status of breastfeeding and the baby’s growth as well as self-management. The advantages of mobile apps include accessibility and self-monitoring capacity. Hence, it is believed that the BFGDM App will self-motivate users to continue breastfeeding. The recording of breastfeeding sessions via a stopwatch was developed with a focus on user convenience, and the function requires only a simple operation. The benefits of using this function are that users can check the previous breastfeeding time and the side used to track the interval between breastfeeding sessions and alternate the breast.
It has been reported that the breastfeeding practice of mothers with diabetes mellitus is influenced by their breastfeeding experience and self-efficacy [9]. The BFGDM App was designed to help increase breastfeeding self-efficacy in mothers with gestational diabetes mellitus by providing an app that uses a message board to share breastfeeding experiences on the community screen and successful breastfeeding stories on the breastfeeding information screen as well as to inspire users to believe that they can also breastfeed successfully. Therefore, it is expected that, particularly in the COVID-19 situation, in which non-face-to-face interaction is encouraged, the use of the BFGDM App will provide emotional support, increased self-efficacy, self-management practices, and experiences of other mothers with the same condition to promote breastfeeding practice among mothers with diabetes mellitus.
The BFGDM App is structured for users to easily obtain information about breastfeeding through text, graphs, and videos; provides features that facilitate sharing of breastfeeding experiences; and provides links to breast management education centers. This app will be an important tool in promoting breastfeeding. It can be used to improve the knowledge, experience, and self-efficacy in breastfeeding of mothers with gestational diabetes mellitus and minimize the impact of the disease on breastfeeding practice among them [9]. In the future, a follow-up study should be conducted to examine the effects of BFGDM App by assessing breastfeeding knowledge, intention, and success in mothers with gestational diabetes mellitus who use the app.