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

Godfred O Boateng, Stephanie L Martin, Emily L Tuthill, Shalean M Collins, Cindy-Lee Dennis, Barnabas K Natamba, Sera L Young, Godfred O Boateng, Stephanie L Martin, Emily L Tuthill, Shalean M Collins, Cindy-Lee Dennis, Barnabas K Natamba, Sera L Young

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.

Keywords: Exclusive breastfeeding; human milk; Psychometric evaluation; Reliability; Scale development; Self-efficacy; Validity.

Conflict of interest statement

Ethical approval and consent to participate

Cornell University’s Institutional Review Board for Human Participants (Protocol ID #1302003634) and Gulu University’s Institutional Review Committee (Reference Number: GU/IRC/02/02/13) approved the PostNAPs study protocol. Permission to conduct the study in Uganda was granted by the Uganda National Council for Science and Technology (HS1261). The ethical approval applies to this current study. Study participants provided a written informed consent before they were enrolled into the study.

Consent for publication

Consent for publication is not necessary for this manuscript as no individual-level data is presented. Only summary data are presented.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Item response clustered bar graph showing response categories for 11 Breastfeeding Self-Efficacy Scale to Measure Exclusive Breastfeeding (BSES-EBF) items (n = 239). “Manage BF” and “Challenging Tasks” were ultimately dropped after exploratory factor analysis; All items are examined at one month postpartum
Fig. 2
Fig. 2
Scree plot showing retained scale factors using exploratory factor analysis at one month postpartum
Fig. 3
Fig. 3
CFA model estimates with residual errors showing a bi-dimensionality of the Breastfeeding Self-Efficacy Scale to Measure Exclusive Breastfeeding (BSES-EBF) Scale at 3 months postpartum (n = 238)
Fig. 4
Fig. 4
Latent variable model standardized estimates and population correlation coefficient for the interrelationship between a. the Cognitive subscale of the BSES-EBF and Informational EBFSS; b. the Cognitive subscale of the BSES-EBF and Emotional EBFSS; c. the Functional subscale of the BSES-EBF and Instrumental EBFSS; d the Latent variable model standardized estimates and population correlation coefficient for the interrelationship between Functional subscale of the BSES-EBF and Informational EBFSS; e. the Latent variable model standardized estimates and population correlation coefficient for the interrelationship between Cognitive subscale of the BSES-EBF and Emotional EBFSS; f. the Functional subscale of the BSES-EBF and CESD Score.

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