Abstract
BackgroundIncreasing 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.MethodsWe 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.ResultsThe 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.ConclusionsThis 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.
Highlights
Increasing the prevalence of optimal breastfeeding practices, including exclusive breastfeeding for 6 months, could prevent an estimated 823,000 child deaths annually
Data on socio-demographic factors, exclusive breastfeeding, exclusive breastfeeding social support, depression, wealth, and other health-related outcomes were collected at 1 week, 1, 3, 6, 9 and 12 months postpartum; only data from 1 and 3 months were used for the development and validation of the Breastfeeding Self-Efficacy Scale (BSES)-Exclusive Breastfeeding (EBF) Scale [24, 26] because information about mother’s breastfeeding self-efficacy was asked at these two time points only
The General Social Support scale produced a mean score of 19.1 ± 4.2, with a Cronbach’s alpha of 0.86
Summary
Increasing the prevalence of optimal breastfeeding practices, including exclusive breastfeeding for 6 months, could prevent an estimated 823,000 child deaths annually. The World Health Organization, Centers for Disease Control and Prevention and American Academy of Pediatrics recommend early initiation of breastfeeding (within one hour of delivery), exclusive breastfeeding for the first 6 months of life and continued breastfeeding for at least two years [4,5,6,7]. Scaling up these optimal breastfeeding practices can prevent an estimated 823,000 child deaths and 20,000 breast cancer deaths every year [6]. 40% of infants younger than 6 months worldwide are exclusively breastfed [2, 9]
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