# Mobile Apps and Websites With Breastfeeding-Related Content in Germany: Cross-Sectional and Evaluation Study

## TL;DR

This study evaluates the quality and content of free digital resources on breastfeeding in Germany, finding generally good quality but challenging readability and commercial bias.

## Contribution

The study provides the first evaluation of free digital breastfeeding resources in Germany using standardized tools.

## Key findings

- Digital breastfeeding resources in Germany showed good quality and suitability but had challenging readability.
- Most evaluated apps and websites were commercial with links to shopping sites lacking trustworthiness verification.
- Nonprofit and governmental support is recommended to improve access to reliable digital breastfeeding information.

## Abstract

Digital technologies with breastfeeding content have become an important source of information for new parents in Germany. However, little is known about the content and quality of digital breastfeeding information sources.

The objective of this paper was to evaluate the scope, content, and quality of free-of-charge smartphone mobile apps and websites with breastfeeding-related content in Germany.

A cross-sectional study of mobile apps and websites was conducted in July 2023. The App Store for iOS and Google Play Store for Android were searched for mobile apps. Bing.de and Google.de were searched for websites. The quality, suitability of information, readability, and coverage of digital information on mobile apps and websites were evaluated. We used the user version of the Mobile Applications Rating Scale, the Health-Related Web Site Evaluation Form, the Suitability Assessment of Materials, and the Flesch Index tool, as well as a self-developed checklist. We report our results according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement.

Eight mobile apps and 13 websites were included. The quality of information sources was generally good for apps (median 83%, IQR 73%‐87%) and websites (median 86%, IQR 83%‐89%). The suitability of information was good for apps (median 84%, IQR 70%‐89%) and websites (median 89%, IQR 78%‐94%). The coverage of information was good for apps (median 68%, IQR 59%‐86%) and websites (median 82%, IQR 73%‐100%). However, digital information was difficult or challenging to read on most apps (median 59%, IQR 53%‐68%) and websites (median 58%, IQR 47%‐61%). Seven of 8 mobile apps and 9 of 13 websites were commercial, with embedded links to shopping sites without external certificates confirming the trustworthiness of the information.

Assertive action from nonprofit and governmental institutions should be provided to support parents with reliable, unbiased, open-access digital breastfeeding information in Germany.