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

Abstract

Introduction While breastfeeding self-efficacy (BSES) is an important modifiable determinant of breastfeeding, a structured assessment is not standard practice in Cyprus. We assessed the Greek version of the Breastfeeding Self-Efficacy Scale (BSES-SF), including its predictive validity in terms of Breastfeeding (BF) and Exclusive Breastfeeding (EBF) up to the sixth month. Methods A methodological study with longitudinal design among 586 mother-infant dyads, as part of the “BrEaST Start in Life” project. BSES was assessed 24–48 h after birth and at the first month. Breastfeeding status was assessed at the clinic, the 1st, 4th and 6th month. The association between BSES and breastfeeding was estimated in logistic regression models and its diagnostic ability in ROC analysis. Results With Mean = 3.55 (SD = 0.85), BSES was moderate, and lower among Cypriot women, primiparas and those who delivered by Cesarean Section (C/S). There was good internal consistency across the 14 items (Cronbach’s α = 0.94) while factor analysis revealed a two-factor structure. BSES scores were higher among mothers who initiated exclusive breastfeeding (M = 3.92, SD = 0.80) compared to breastfeeding not exclusively (M = 3.29, SD = 0.84) and not breastfeeding (M = 3.04, SD = 1.09; p-value < 0.001). There was a stepwise association with exclusivity (40.5% in the highest vs 7.9% lowest quartile of self-efficacy). The association between in-hospital BSES and long-term EBF persisted in multivariable models. Women in the upper quartile of BSES at 48 h were more likely to breastfeed exclusively by adjOR = 5.3 (95% CI 1.7–17.1) at the 1st and adjOR = 13.7 (95% CI 2.7–68.6) at the 4th month. Similar associations were observed between self-efficacy at the 1st month and BF at subsequent time-points. High first month BSES (> 3.96 as per ROC) had 58.9% positive and 79.6% negative predictive value for breastfeeding at 6 months which reflects higher sensitivity but lower specificity. Conclusions The Greek version of BSES-SF showed good metric properties (construct, know-group, concurrent and predictive validity). In the absence of community support structures or programmes in Cyprus, prevalence of breastfeeding remains low. This suggests a need for policy, educational and community support interventions, including the systematic use of BSES scale as a screening tool to identify those at higher risk for premature BF discontinuation.

Determinants of Exclusive Breastfeeding and Mixed Feeding Among Mothers of Infants in Dubai and Sharjah, United Arab Emirates

“…The study also showed that women who breastfed their infants for more than 6 months and those who currently breastfed their infants were significantly more likely to undergo EBF than the others. This finding was consistent with the results of a study conducted in Cyprus ( 58 ). This could be related to the fact that women who feel committed to breastfeeding their infants will be more likely to dedicate themselves to EBF at an early stage; on the other hand, women who choose not to feed for more than 6 months would be more likely not highly dedicated and committed to EBF and prone to mixed feeding.…”

Effects of the experience of breastfeeding-friendly practices and breastfeeding intention and self-efficacy on breastfeeding behavior: a cohort study in Taiwan

“…Breastfeeding intention and self-efficacy were the major baseline predictors of breastfeeding duration within the first 6 months postpartum, reflecting similar results of studies in Taiwan and other high-income countries [ 9 , 13 , 14 , 41 ]. Maternal and pediatric health care professionals must assess the probability of breastfeeding termination within these initial 6 months, assess breastfeeding self-efficacy repeatedly after a mother’s discharge, recognize the main factors affecting breastfeeding at each stage, and support the extension of breastfeeding duration up to 6 months according to the factors at each stage.…”

Determinan Kegagalan Pemberian Asi Eksklusif Pada Ibu Menyusui Di Wilayah Puskesmas Banda Raya Kota Banda Aceh

“…Pemberian ASI eksklusif 6 bulan awal kehidupan sanggup kurangi 13% kematian balita serta jadi salah satu strategi pengukuran dalam upaya menaikkan status gizi serta kelangsungan hidup balita. (Berlanga-Macías et al, 2018;Economou et al, 2021).…”