Adaptation and psychometric evaluation of the breastfeeding self-efficacy scale to assess exclusive breastfeeding

Abstract

Background Increasing the prevalence of optimal breastfeeding practices, including exclusive breastfeeding for 6 months, could prevent an estimated 823,000 child deaths annually. Self-efficacy is an important determinant of breastfeeding behaviors. However, existing measures do not specifically assess exclusive breastfeeding self-efficacy, but rather self-efficacy for any breastfeeding. Hence, we sought to adapt and validate an instrument to measure exclusive breastfeeding self-efficacy. Methods We modified and added items from Dennis’ Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). It was then implemented in an observational cohort in Gulu, Uganda at 1 ( n = 239) and 3 ( n = 238) months postpartum ( clinicaltrials.gov NCT02925429). We performed inter-item and adjusted item-test correlations, as well as exploratory factor analysis and parallel analysis at 1 month postpartum to remove redundant items and determine their latent factor structure. We further applied confirmatory factor analysis to test dimensionality of the scale at 3 months postpartum. We then assessed the reliability of the scale and conducted tests of predictive and discriminant validity. Known group comparisons were made by primiparous status and correct breastfeeding knowledge. Results The modification of the original BSES-SF to target exclusive breastfeeding produced 19 items, which were reduced to 9 based on item correlations and factor loadings. Two dimensions of the adapted scale, the Breastfeeding Self-Efficacy Scale to Measure Exclusive Breastfeeding BSES-EBF emerged: Cognitive and Functional subscales, with alpha coefficients of 0.85 and 0.79 at 3 months postpartum. Predictive and discriminant validity and known group comparisons assessments supported its validity. Conclusions This version of the Breastfeeding Self-Efficacy scale, the BSES-EBF Scale, is valid and reliable for measuring exclusive breastfeeding self-efficacy in northern Uganda, and ready for adaptation and validation for clinical and programmatic use elsewhere. Electronic supplementary material The online version of this article (10.1186/s12884-019-2217-7) contains supplementary material, which is available to authorized users.

Black/African American Breastfeeding Experience: Cultural, Sociological, and Health Dimensions Through an Equity Lens

“…7 BF also provides lifelong infant health benefits; the longer infants exclusively breastfeed, the greater benefit in reducing infantile and respiratory diseases (COVID- 19), sudden infant death syndrome, and chronic diseases related to obesity. [8][9][10][11][12] Ultimately, the public health burden of not BF results in a global gross expenditure of U.S. $341.3 billion, with $114.97 billion incurred by the North America Region. 13 The early cessation of BF (before 3 weeks) costs the United States an estimated $3.0 billion annually (2010 dollars) due to purchase of formula, increased infantile diseases and health visits, and lost wages ($2.3 billion being maternal costs).…”

The association of breastfeeding self-efficacy with breastfeeding duration and exclusivity: longitudinal assessment of the predictive validity of the Greek version of the BSES-SF tool

“…It has been extensively used in studies among the general population of mothers or specific population groups; adolescents [24], primiparas [25][26][27], ethnic minorities [28][29][30], low income [31] and many more. Only recently, a 9-item exclusive breastfeeding specific selfefficacy scale was developed on the basis of Dennis BFSE-SF scale to assess EBF where breastfeeding is common, with very good psychometric properties [32]. Research evidence suggests a positive predictive association of breastfeeding self-efficacy and breastfeeding initiation, duration and exclusivity [17,18,20,[22][23][24]31].…”

An evaluation of a prenatal individualised mixed management intervention addressing breastfeeding outcomes and postpartum depression: A randomised controlled trial

“…Despite the substantive benefits of optimal breastfeeding and the risks of non-exclusive breastfeeding, exclusive breastfeeding rates remain low (Boateng et al, 2019). A national survey from the Centers for Disease Control and Prevention (CDC, 2018) found that, in the United States, 83.2% of mothers start to breastfeed, and only 24.9% exclusively breastfeed through 6 months.…”

“…There is a need to understand breastfeeding barriers in order to develop appropriate strategies to promote and support breastfeeding (Taha et al, 2018). Many determinants have been identified that deter breastfeeding behaviour (Boateng et al, 2019). Recent studies indicate that women who are depressed during pregnancy are more likely to discontinue breastfeeding than those with no depressive symptoms while pregnant (Amiel Castro et al, 2017; Tuthill et al, 2017).…”