Smartphone parenting apps, content quality, and hidden milk formula advertisements

Abstract

The World Health Organization defines mobile health (mHealth) as using mobile devices to support medical and public health practice. mHealth apps are proliferating rapidly, reaching a wide range of target audiences, and could potentially be a valuable platform delivering behaviour change interventions. There were approximately 325,000 mHealth apps publicly available by the end of 2018. In China, accessing information from digital media sources, especially parenting apps, has become a routine part of the maternity experience for many expectant and new mothers. Parenting apps are likely to influence those women’s breastfeeding and health and infant and young child feeding behaviour. Despite the increasing popularity, the content quality of parenting apps and the relevant evaluation standards have not been explored; the accuracy and usefulness of the information are unknown. The milk formula market is booming globally, China is now the biggest milk formula market. The International Code of Marketing of Breastmilk Substitutes (the Code) prohibits the promotion of breastmilk substitutes (BMS) to the general public. The BMS include all milk formula products, such as infant formula, follow-up formula, toddler formula and growing up formula, for children up to 36 months. However, milk formula advertising has been increasingly promoted through digital media including Facebook, Twitter and apps. Yet, how these advertising practices and messages promoted by formula companies undermine breastfeeding, particularly in China, have not been investigated. The aims of my PhD research are twofold, to investigate: 1) Whether the parenting apps are communicating accurate and reliable breastfeeding promotion messages; 2) How the milk formula industry uses digital media, including apps to advertise and promote milk formula products. Firstly, a comprehensive review of literature on health behaviour change using mHealth apps in peer-reviewed journals was conducted in a broader range of intervention studies. Secondly, we searched for free-to-download Chinese infant feeding apps in the iTunes and Android App Stores and identified 26 apps. We conducted a comprehensive content quality assessment of these apps for the accountability, scientific basis, accuracy of information relevant to infant feeding, advertising policy, and functionality using a set of criteria we developed. We also carried out a preliminary screening of infant formula advertisements in the apps. Thirdly, we developed a coding tool for categorizing marketing techniques. The tool consists of 22 coding options across 4 categories: namely emotional imagery, marketing elements, claims, and advertising disclosure. Using the coding tool, we conducted a content analysis of milk formula advertisements identified in parenting apps. Finally, given the popularity of Weibo (Chinese Twitter), we developed the content analysis of posts published by the most popular milk formula brand in their official Weibo accounts between 1 January 2018 and 31 December 2018. The results revealed that most information in the parenting apps evaluated were lacking scientific basis and credibility, and the messages often misleading. We also discovered a large number of commercial advertisements of milk formula on the apps that used arrange of marketing tactics. Similarly, some Weibo posts enticed customers to engage with the company online and promote their BMS products directly to the new and expecting parents. Although the parenting apps could be a valuable platform for accessing evidence-based child health and feeding information, the quality of the contents need to be improved to reach the full potential of their effectiveness. The penetration of commercial activities of milk formula industry in apps and social media needs to be urgently recognised and regulated. Policymakers and legislators should play a vital role in creating enabling environments for breastfeeding.