Exploring the barriers to equitable access of digital health breast- and chest-feeding support

Background: The complexity of healthcare systems creates unique challenges for those seeking lactation support and threatens the universality of healthcare coverage. Digital health interventions present one solution to mitigating barriers observed with traditional in-person lactation support. The main objective of this study is to evaluate digital health interventions used for breast- and chest-feeding support among perinatal families and identify barriers to accessing these resources. Methods: An integrative literature review guided by Whittemore and Knafl’s methodology was performed to answer the PICO question: “What barriers affect access to and use of digital breast- and chest-feeding services among perinatal families?” An advanced search was conducted in three databases (CINAHL n=244; EBSCO MEDLINE n=294; and Web of Science Core Collection n=442). Articles were screened based on the following inclusion criteria: a population of perinatal families, using a digital health breast- and chest-feeding support intervention, and an outcome related to accessing and using these supports. Limits were applied to include articles published in the last 10 years and available in English. Results: A total of 980 records were retrieved of which 14 records met the inclusion criteria and were included in the review. Using constant comparison, several themes emerged as barriers to accessing digital breast- and chest-feeding supports, with three major areas of focus: inclusion and diversity in research, health literacy, and digital equity. Conclusions: Addressing access in health care is difficult due to the nature of service delivery and the differing systems involved. There is limited research in Canadian contexts. Future research could expand locations, involve more inclusive populations (clients and providers), and design new tools in partnership with the intended user population(s).