Formative Research for the Development and Implementation of a Smartphone Application to Report Breaches to the International Code of Marketing of Breast Milk Substitutes in Mexico

Abstract

Almost 40 years after the adoption of the International Code of Marketing of Breast-Milk Substitutes (‘the Code’) in Mexico, noncompliance persists. In other countries, smartphone applications for reporting Code noncompliance have proven effective. This study aimed to identify key features for the design of a public health surveillance app to monitor Code breaches and the barriers and facilitators to its use by parents and stakeholders. Semi-structured interviews (n = 34) and focus groups (n = 14) with key stakeholders (n = 81), including parents and caregivers, health care personnel, representatives of academia, civil society organizations and government entities, were conducted between August and December 2023. Transcripts were analysed in MAXQDA 20 software using grounded theory ‘lite’, which emphasizes the construction of categories and concepts to explore and structure participant perspectives. Four categories were constructed from the coding process: (a) knowledge and perspectives about the Code; (b) attitudes towards reporting Code breaches and any subsequent repercussions; (c) stakeholders perspectives on monitoring the Code and (d) perspectives on the app. Mexican stakeholders supported the development of an app and associated website to monitor the Code, indicated a willingness to report breaches, and believed that a national committee and state bodies should oversee surveillance and monitoring activities of the Code. Adapting legal measures with appropriate sanctions and making infractions public were recommended. Developing an app assisted with artificial intelligence could aid the establishment of a national monitoring system for the Code, make infractions public, promote societal participation, and drive regulatory changes for commercial milk formula marketing.

Summary

There is a general lack of knowledge about the Code and the subsequent resolutions that only very specialized profiles recognize.

Health professionals, CSOs, government, parents, and academics showed strong interest in the AI-powered mobile app to report Code breaches, with participants eager to report breaches if the app is easy to use, free from conflict of interest and triggers action.