Unidimensional Solution Research Articles

Revisiting the English Short Measure for Adult Playfulness (SMAP): An Investigation of Reliability, Validity, and Cross-Cultural Comparisons

Adult playfulness describes the personality of the quick initiation and strong intensity of enjoyable experiences coupled with the frequency of engaging in playful behaviors. In addition to examining the reliability and validity of the Short Measure for Adult Playfulness (SMAP), we compared the psychometric properties of the SMAP across (a) 4- and 7-point answer formats; (b) German and English language versions; and (c) gender. The SMAP and criterion validity measures were distributed across three independent samples from Canada (N total = 1,177) and a German sample (N = 660). Results supported a unidimensional solution with strong factor loadings for all items (>.50 across all samples) and high test-retest reliability (r = .67, BF10>100). In item response theory analyses, high discrimination parameters were found across the latent continuum. Although both the four-point and seven-point Likert scale versions showed robust item properties, the seven-point Likert scale version yielded more precise measurement of higher playfulness (θ > 1.50). No significant differential item functioning was located across gender or language. Finally, results supported external construct validity via associations with broad personality traits, humor, and orientations to happiness. The present investigation provides support for the reliability and validity of the English SMAP for concise adult playfulness measurement.

Greek School Nurses' Confidence With Diabetes Devices.

Aim School nurses often use diabetes mellitus devices as part of the care provided to students with Type 1 Diabetes Mellitus. The aim of this study was to explore the psychometric properties of the Greek version of the Diabetes Devices Confidence Scale (DDCS). Methods In this cross-sectional, descriptive study, 143 school nurses completed the DDCS. This is a self-administered questionnaire exploring the nurses' confidence in the use of diabetes devices. The scale was translated and culturally adapted according to the WHO guidelines. The Intraclass Correlation Coefficient and Cronbach's Alpha Index were used to explore the reliability and internal consistency, respectively. The construct validity was tested via exploratory and confirmatory factor analysis (EFA, CFA). Data were analyzed via Statistical Package for the Social Sciences (SPSS), version 22.0 (IBM Corp., Armonk, NY, USA). Results Significant correlations were observed between the two administrations (p<0.001) indicating the good reliability of the scale (ICC = 0525, p<0.001) while Cronbach's Alpha was 0.966 suggesting excellent internal consistency. The EFA resulted in a unidimensional solution explaining 53.7% of the total variance. The CFA showed that the model presents good fit to the data. Conclusions The DDCS is a reliable and valid tool to test the nurses' confidence in diabetes devices.

The Imperfect Yet Valuable Difficulties in Emotion Regulation Scale: Factor Structure, Dimensionality, and Possible Cutoff Score.

The Difficulties in Emotion Regulation Scale (DERS) is frequently used to assess emotion regulation (ER) capabilities. Originally a multidimensional scale, many utilize its total score, without clear recommendations. We aimed to explore the DERS's structure, dimensionality, and utility and provide clinicians and researchers with clear guidelines. Self-report data on ER, personality, psychopathology, and life satisfaction were collected from 502 adults. Seventy also participated in a lab study evaluating group interactions, which included additional self-report and physiological monitoring. Findings suggested favoring the correlated-traits and bifactor models, the latter excelling in direct comparisons. The total score was found reliable and valid, explaining 53.3% of the variance, with a distinct emotional awareness subfactor, suggesting a non-pure unidimensional solution. A cutoff score of 95 identified significant ER difficulties, linked to psychopathology. We thus recommend using the DERS's total score and 95 as its cutoff, while calling for further validation in diverse and clinical samples.

Exploring Older Adults' Subjective Views on Aging Positively: Development and Validation of the Positive Aging Scale.

Historically, aging research has focused primarily on health deterioration and negative aspects associated with aging. This has limited the scope of our understanding of the experience of aging and the relationships between aging and well-being from an integrative biopsychosocial perspective. In the same vein, there is a lack of reliable and valid assessments of aging that capture the positive aspects that characterize and improve the subjective experience of this period of life, particularly one that focuses on psychosocial well-being, including meaningful experiences and activities, group memberships, and general abilities. This study presents the development and validation of the Positive Aging Scale (PAS), a novel self-report assessment. This was an online cross-sectional study conducted on 501 UK residents aged ≥60 years. A number of self-reported items and measures of positive aging, general health, well-being, and cognitive functioning were administered to the sample. We used exploratory and confirmatory factor analyses and assessed the dimensionality, reliability, and concurrent criterion-related validity of the PAS. The results suggested that a unidimensional solution represents the data well, with the positive aging factor adequately loading on 8 items, and the solution showing factorial invariance between young-old and old participants (i.e., ≥75 years). Total PAS scores positively correlate with general health, well-being, and cognitive functioning. The PAS demonstrated strong psychometric properties and the findings highlight correlations between the PAS and key outcomes of positive aging, including general health. Implications for research and interventions are discussed.

Psychometric properties of a brief non-verbal test of g factor intelligence

Intelligence is the most studied construct in psychology and cognitive neuroscience. In Brazil, the administration of intelligence tests is needed for a number of social rights, including driving privileges. Such requirements have led to a large testing industry but the vast majority of intelligence tests require extended administration times and language skills. In this study, we sought to investigate the psychometric properties and normative results of a new non-verbal intelligence test, the General Matrix of Intelligence (GMI). The GMI is comprised of 28 matrix-based items and can be administered in as little as six-minutes. In this initial pilot test, the GMI was administered to 1,326 participants, ages 15-64 years old (M = 25.65 years, SD = 9.6 years), from all regions in Brazil. These data were analyzed using a 2PL Item Response Theory model, regression analyses were conducted to determine the role of sociodemographic factors, and preliminary norms were computed. Results indicated a unidimensional solution that reproduced the g factor theory, invariance across genders, evidence that cognitively demanding items involving movement or three-dimensional shapes were more difficult than items with less cognitive load, a normal distribution for results, and an interaction between education level and age group in predicting performance. Implications of these findings for research and practice are discussed and all data and codes are provided at https://osf.io/kvu42/

Validation of the inventory of acts of cyberbullying in the workplace (ICA-W)

Workplace cyberbullying is an emerging phenomenon that has received little attention in the academic literature. This research sought to validate an instrument to measure cyberbullying in work contexts. The ICA-W scale of Vranjes et al. (2018) was translated, and an exploration of its psychometric properties was conducted. Validity was assessed by exploratory factor analysis and through nomological network analysis with the constructs of psychological harassment, life satisfaction, and subjective happiness. The results support the quality of the instrument, finding a reliability of .88 and convergent validity with the psychological harassment scale (rho = .52), as well as divergent validity with the satisfaction with life scale (rho = -.17). Factor analysis revealed a unidimensional solution that explained 65% of the variance. It is concluded that the ICA-W scale is reliable and valid, but assuming certain restrictions in its application in Chilean workers.

A 13-item Health of the Nation Outcome Scale (HoNOS-13): validation by item response theory (IRT) in patients with substance use disorder

BackgroundThe Health of the Nation Outcome Scale (HoNOS) is a widely used 12-item tool to assess mental health and social functioning. The French version has an added 13th item measuring adherence to psychotropic medication. The aim of the current study is to uncover the unknown pattern of the new item 13 and to compare the unidimensional and multidimensional fit of the new HoNOS-13 using Item Response Theory (IRT). This research question was studied among inpatients with substance use disorder (SUD).MethodsSix hundred and nine valid questionnaires of HoNOS-13 were analyzed using unidimensional (one-factor) and multidimensional (two-factor) IRT modeling.ResultsThe multidimensional model suggesting a first factor capturing psychiatric/impairment-related issues and a second factor reflecting social-related issues yielded better goodness-of-fit values compared to the unidimensional solution. This resulted in an improvement of all slope parameters which in turn translates to better discriminative power. Significant improvement in item location parameters were observed as well. The new item 13 had a good discriminative power (1.17) and covered a wide range of the latent trait (− 0.14 to 2.64).ConclusionsWe were able to validate the 13-item questionnaire including medication compliance and suggest that the HoNOS-13 can be recommended as a clinical evaluation tool to assess the problems and treatment needs for inpatients with SUD. Interestingly, the majority of item response categories are endorsed by respondents who are below and above the average levels of HoNOS. This indicates that the scale is able to discriminate between participants both at the low and at the high ends of the latent trait continuum. More importantly, the new item 13 has a good discriminative power and covers a broad range of the latent trait below and above the mean. It therefore has the desired profile of a good item and is a useful measure for the assessment of mental health and social functioning.Trial registration ClinicalTrials.gov, Identifier: NCT03551301. Registered: 11.06.2018. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03551301.

Adaptation and validation of the Adult Dispositional Hope Scale in the Ecuadorian context

This study aimed to evidence the validity and reliability of the Ecuadorian version of the Adult Dispositional Hope Scale, one of the most studied concepts of positive psychology. The adaptation process included translation and semantic and idiomatic validation. For content validation, an expert review and focus group were conducted. The questionnaire was applied to 2423 workers in Ecuador with a mean age of 37 years (SD = 9.04), and 65.6% were women. A confirmatory factor analysis was conducted to assess the validity of the scale’s dimensionality. The reliability and convergent and discriminant validity were also evaluated. In order to investigate the best solution for an Ecuadorian version of the Adult Dispositional Hope Scale, four structural models were assessed. The unidimensional solution was the most adequate structure for the scale. The internal consistency of the scale was adequate. The Adult Dispositional Hope Scale (ADHS) was developed to assess this positive psychological state and has been the most used tool in many contexts. To our knowledge, this study is the first to adapt the Adult Dispositional Hope Scale into the Ecuadorian context and evaluate its validity. The findings support its reliability, factorial, and construct validity in the Ecuadorian context. Furthermore, the results show that dispositional hope acts as a protective factor, promoting work engagement and preventing burnout.

Lack of voluntary interest and difficulty making eye contact are the most discriminative behaviors of the ASQ:SE and might suggest delays: Results from a large-scale assessment

Background Every child is unique, but development tends to occur in predictable steps and stages. The early identification of infants who face developmental delays is critical, boosting the use of screening tools to determine risks for delays. The city of Rio de Janeiro conducted a large-scale assessment of children who were enrolled in educational facilities using the Ages & Stages Questionnaires: Social-Emotional (ASQ:SE). Objectives We examined the internal structure of the ASQ:SE and its most discriminative items of risks of delays in development among 12- to 60-month-old children. The trajectory of the discrimination parameter of eight anchor items was used to check how well they inform the risk of social-emotional competence delays throughout development. Methods Data from 79,332 children (1–5 years) were analyzed via Samejima Graded Response model of Item Response Theory (IRT). The discrimination (a) and threshold (b) parameters were computed, and errors were achieved via maximum likelihood. Data/codes are available at https://osf.io/by6sf/. Results (a) Item Response Theory analyses supported the unidimensionality of data via the root mean square error of approximation and standardized root mean square residual results (RMSEA). (b) The lack of voluntary interest was the most discriminative risk behavior in the first 5 years. (c) Lack of interest was the most persistent risk behavior. (d) Difficulty making eye contact was nearly as informative as lack of interest. Conclusion Lack of voluntary interest in things should be considered a critical risk-related behavior, and making eye contact is a vital aspect of typical development. Both behaviors may be predictors of children’s delays. MAIN OUTCOMES The ASQ:SE is a valid and reliable tool to measure child development. The internal structure of the ASQ:SE is well-fitted with a unidimensional solution. A child’s age is a vital aspect of the discrimination parameter of the IRT model. Lack of interest in things and difficulty making eye contact are critical risk-related behaviors.

Adaptação da Escala de Desamparo Aprendido no Brasil

Abstract The present study aimed to adapt the Learned Helplessness Scale (LHS) to Brazilian Portuguese and assess its psychometric properties and nomological network in a Brazilian sample. Participants completed an online survey that consisted of the LHS, Rosenberg’s Self-Esteem Scale, and the Perceived Stress Scale. 429 people participated, aged 18-79, mostly women, from multiple regions of Brazil and socioeconomic status. Exploratory and Confirmatory Factor Analysis suggested a unidimensional solution with 18 items as appropriate. Correlations between the LHS and the other instruments also provided evidence of the expected nomological relationships. And we assessed the differences in LHS scores by sociodemographic data. These findings are favorable to the use of this instrument in Brazilian samples.

A Czech version of the Overall Anxiety Severity and Impairment Scale (OASIS): standardization and psychometric properties

BackgroundThe Overall Anxiety Severity and Impairment Scale (OASIS) is a transdiagnostic measure that assesses severity and impairment associated with anxiety disorders. However, its psychometric properties were primarily examined in English-speaking or western countries. Therefore, this study aims to examine its psychometric parameters in the Czech Republic.MethodsA large representative sample (n = 1738), a clinical sample (n = 57) and a retest sample (n = 20) were used. In addition to the OASIS, conventional measures of anxiety, depression, personality traits, self-esteem, life satisfaction, and other scales were also administered. Moreover, we examined the latent structure, reliability, validity, and the cut-off score for the Reliable Change Index (RCI) and the Clinically Significant Change Index (CSI).ResultsHigher anxiety was found in females, religious non-church members, and students. The Confirmatory Factor Analysis supported the adequate fit of the unidimensional solution: x2(4) = 3.20; p < 0.525; CFI = 1.000; TLI = 1.000;RMSEA = 0, SRMR = 0. The measurement equivalence examination indicated that the OASIS measures anxiety invariantly between males and females. The validity of the OASIS was supported by positive associations with neuroticism, depression, perceived stress, guilt, shame, and the established anxiety measures. The internal consistency was excellent (Cronbach’s alpha = 0.96, McDonald’s omega = 0.96). The test-retest reliability was acceptable (r = 0.66). The cut-off for the CSI is 6 and the RCI is 5.32.ConclusionsThe OASIS represents a reliable and valid instrument for assessing anxiety in adults. Due to its shortness, excellent psychometric properties, and percentile norms, it is especially useful for short and accurate screening of anxiety and mapping therapeutic changes in clinical practice.

Measuring Positive Mental Health and Depression in Africa: A Variable-Based and Person-Centred Analysis of the Dual-Continua Model.

The dual-continua model of mental health provides a contemporary framework for conceptualising and operationalising mental health. According to this model, mental health is distinct from but related to mental illness, and not the opposite or merely the absence of psychopathology symptoms. To examine the validity of the dual-continua model, previous studies have either applied variable-based analysis such as confirmatory factor analysis (CFA), or used predetermined cut-off points for subgroup division. The present study extends this contribution by subjecting data from an African sample to both CFA and latent class analysis (LCA) to test the dual-continua model in Africa. We applied CFA separately for the Mental Health Continuum—Short Form (MHC-SF) and Patient Health Questionnaire—9 (PHQ-9); and LCA on combined item responses. College students (N = 892; average age = 22.74, SD = 4.92; female = 58%) from Ghana (n = 309), Kenya (n = 262), Mozambique (n = 232), and South Africa (n = 89) completed the MHC-SF and PHQ-9. With minor modifications to the measurement models, the CFA results of this study confirm the three-factor structure of the MHC-SF, and a unidimensional solution for the PHQ-9. LCA results show the presence of three distinct latent classes: languishing with moderate endorsement of depressive symptoms (25.9%), flourishing with low endorsement of depressive symptoms (63.7%), and moderate mental health with high endorsement of depressive symptoms (10.4%). These findings further contribute to affirming the evidence for the dual-continua model of mental health, with implications for the assessment of mental health, to inform policy, practise, and future research in community and clinical settings in Africa.

Brain structural abnormalities in six major psychiatric disorders: shared variation and network perspectives.

Common brain abnormalities are a possible explanation for comorbidities in psychiatric disorders. Challenges in understanding these conditions are likely due to the paucity of studies able to analyze the extent and regional distribution of shared morphometric abnormalities between disorders. Recently, Opeal et al. presented an elegant rationale to investigate shared and specific morphometric measures of cortical thickness and subcortical gray matter volume between healthy individuals and subjects across six major psychiatric disorders. Although their approach has the potential to systematically portray shared brain alterations, the chosen principal component analysis solution may not address the central question of the observed shared versus specific brain alterations due to misspecification of the number of components. Given how this misspecification can lead to different conclusions, we reanalyzed Opel et al. data to thoroughly determine the number of factors to be considered, explore the alternative solution, and visualize the patterns of shared brain matter correlations using network analysis. Our approach suggests that a unidimensional solution was appropriate in this situation. The unidimensional solution indicated that brain alterations in autism spectrum disorder (ASD) had a significant negative component loading, suggesting that brain abnormalities found in ASD covaried with major depressive disorder (MDD), bipolar disorder (BD), schizophrenia (SCZ), and obsessive-compulsive disorder (OCD), a finding not demonstrated by the original work. Network analysis indicated that SCZ had the highest strength, BD the highest closeness, and BD and MDD had the highest betweenness in the network. This work highlights how different component solutions can lead to different conclusions, with important implications for the understanding of overlapped patterns of symptoms among six major psychiatric diseases. The network approach is complementary in indicating central markers of specific psychopathology domains. Investigations using shared-variation and network perspectives are promising for the study of pathophysiological patterns of common brain alterations.

Should We Use a Total Score, Two Subscale Scores, or Six Subscale Scores for the Self-Compassion Scale? A Multi-faceted Assessment Beyond Model Fit Indices

ObjectivesThe aim of this study was to conduct a multi-faceted assessment of the psychometric properties of the Self-Compassion Scale (SCS). In addition to the goodness-of-fit, we aimed to assess the strength and replicability of three factorial solutions, and the quality and effectiveness of the three scoring schemes of the scale (i.e., total scale score, two subscale scores, and six subscale scores).MethodsParticipants were 1508 Spanish-speaking community-dwelling adults (M = 34.94 years, SD = 15.02). Data were examined by means of a conjoint strategy using Rasch modeling, non-linear factor analysis, exploratory bifactor analysis, and parallel analysis. A procedure for selecting the optimal set of items that must be used to compute individual’s scores was used.ResultsThe unidimensional solution showed a marginal model fit (RMSR = .089), and both the bifactor two-group and bifactor six-group solutions showed a good fit (RMSR = .043 and .019, respectively). However, only the unidimensional and the bifactor two-factor solutions showed interpretable and replicable factor structures, and high-quality and effective scores to be used for measurement purposes. Subscale scores derived from the six primary factors did not show adequate psychometric properties. It was observed that the information provided by 10 items was redundant and had already been provided by the other 16 items.ConclusionsGood model fit is neither sufficient nor necessary to justify the use of a scoring scheme. Goodness-of-fit statistics should be complemented by an assessment of the metric properties of the resulting scores when proposing SCS scoring schemes.

Assessment of Criteria for Specific Internet-use Disorders (ACSID-11): Introduction of a new screening instrument capturing ICD-11 criteria for gaming disorder and other potential Internet-use disorders.

Background and aimsWith the inclusion of gaming disorder in the ICD-11, diagnostic criteria were introduced for this relatively new disorder. These criteria may also be applied to other potential specific Internet-use disorders, which may be classified in ICD-11 as other disorders due to addictive behaviors, such as online buying-shopping disorder, online pornography-use disorder, social-networks-use disorder, and online gambling disorder. Due to the heterogeneity in existing instruments, we aimed to develop a consistent and economic measure of major types of (potential) specific Internet-use disorders based on ICD-11 criteria for gaming disorder.MethodsThe new 11-item Assessment of Criteria for Specific Internet-use Disorders (ACSID-11) measures five behavioral addictions with the same set of items by following the principles of WHO’s ASSIST. The ACSID-11 was administered to active Internet users (N = 985) together with an adaptation of the Ten-Item Internet Gaming Disorder Test (IGDT-10) and screeners for mental health. We used Confirmatory Factor Analyses to analyze the factor structure of ACSID-11.ResultsThe assumed four-factorial structure was confirmed and was superior to the unidimensional solution. This applied to gaming disorder and to the other specific Internet-use disorders. ACSID-11 scores correlated with IGDT-10 as well as with the measures of psychological distress.Discussion and ConclusionsThe ACSID-11 seems to be suitable for the consistent assessment of (potential) specific Internet-use disorders based on ICD-11 diagnostic criteria for gaming disorder. The ACSID-11 may be a useful and economic instrument for studying various behavioral addictions with the same items and improving comparability.

Factor structure of the Dispositional Hope Scale amongst South Africans: An exploratory structural equation modelling study

Snyder’s model of hope conceptualises and operationalises hope as a cognitive, trait-like bi-dimensional future-oriented construct consisting of pathways thinking and agency thinking for goal achievement. The present study implemented exploratory structural equation modelling (ESEM) and confirmatory factor analysis (CFA) on the Dispositional Hope Scale, using data from two South African student samples (n = 383, 48% female, 21.70 years average age and n = 251, 68% female, 20.55 years average age), with the aim to examine its factor structure in an African context. The results showed that a six item unidimensional solution of hope fit the data best. This model characterises hope as the ability to make plans, informed by past experiences and to spontaneously manoeuvre around obstacles as any situation may call for it. This finding has implications for the measurement of hope and development of emic operational models in an African context.

Escala de Crença em Seres Espirituais (ECSE): Desenvolvimento e Validação Inicial

Abstract Although belief in spiritual beings can be considered the main characteristic of religiosity/spirituality, a scale focused on specifically assessing this construct while remaining pertinent to people of different religious/spiritual denominations-including atheists and agnostics-is not available. In two studies, we present the process of developing the Belief in Spiritual Beings Scale (BSBS) and identify its psychometric properties. Study 1 designed 24 items, which were subsequently evaluated by a panel of judges and 24 representatives of the target population. In study 2, 1788 Brazilians of different religious/spiritual denominations answered the BSBS and five other related scales. Exploratory factor analysis found a unidimensional solution for the data, with the final version of the scale consisting of 13 items. The BSBS score correlated positively-highly or moderately-with measurements of organizational religious activity, non-organizational religious activity, intrinsic religiosity, and Western and Eastern religious beliefs. The level of belief/disbelief in spiritual beings was different among contrasting groups (i.e., religious spiritualists, non-religious spiritualists, gnostic non-spiritualists or atheists, and agnostic non-spiritualists or agnostics), and incrementally predicted almost all the participants’ spiritual denominations. Given this preliminary evidence of validity, the BSBS is an interesting instrument for studies aiming to measure the general level of belief/disbelief in spiritual beings-the “soul” of religiosity/spirituality.

Ментальная устойчивость: русская версия шкалы измерений (MTQ18)

A special role in the study of personal security problems is played by the study of psychological stability and mental toughness, the development of which involves the ability of a person to focus on one occupation without dispersing their forces, the ability to bring any business started to completion, overcoming the fear of the new, an adequate attitude to their mistakes, the ability to think in a positive way, resistance to force-majeure situations and the ability do not give in to impulses, stress resistance and other qualities.&#x0D; In the article, the authors proposed a Mental Toughness Questionnaire.&#x0D; The 18-item Mental Toughness Questionnaire (MTQ18) is a brief, widely used measure of mental toughness. The MTQ18 derives from the longer MTQ48, which comprises four independent but correlated factors (Challenge, Commitment, Control and Confidence). Despite sampling items from across MTQ48 dimensions, the MTQ18 (as intended) provides a global, unidimensional score. The current paper translated the MTQ18 into Russian, and consequently assessed validity and reliability (factorial, internal and convergent) in a general population sample of 1150 participants (432 male and 718 female). Confirmatory factor analysis (CFA) revealed the MTQ18 possessed additional variance to that accounted for by a unidimensional solution. Moreover, analyses via exploratory structural equation modelling demonstrated better data-model fit for a four-factor model than CFA. However, factors of Control and Challenge demonstrated inconsistent item loadings. Tests of convergent validity revealed the MTQ18 correlated with theoretically related measures. Overall, although the MTQ18 was a psychometrically acceptable measure, issues with factorial structure require reconciliation in future research.

Germany should reflect on its rich theoretical tradition

Germany should reflect on its rich theoretical tradition

Development and psychometric testing of the ‘Mindful Breastfeeding Scale’ (MINDF-BFS) among postpartum women in Turkey

The aim of the study is to develop and psychometrically test the Mindfulness Breastfeeding Scale among postnatal women. Cross-sectional data were collected during 2017–2018 in Antalya Education and Research Hospital. The total sample comprised 500 post-partum women who met the inclusion criteria: (1) Women older than 18 years, who were literate in Turkish, (2) women without a disease or drug treatment that would prevent breastfeeding, and (3) mothers with a healthy baby. Missing was low in frequency (5.4%). A unidimensional solution has been observed as a result of exploratory and confirmative factor analyses. Low reliability and validity were obtained in seven of the original 16 items; excluding these items, the one-dimensional 9-items measurement model revealed good model fit, indicating good internal consistency and validity. Significant factor loadings, goodness-of-fit indices and a significant correlation in the expected direction with breastfeeding self-efficacy supported reliability and validity of the Mindfulness Breastfeeding Scale. Exploring the essence of mindfulness in breastfeeding and its health-promoting potential is highly warranted. Such knowledge and a well-adapted scale are beneficial and important for the further development of health-promoting postnatal care.