Adaptation and validation of the Iowa infant feeding attitude scale and the breastfeeding knowledge questionnaire for use in an Ethiopian setting

Abstract

Background: Validated instruments to assess breastfeeding knowledge and attitude are non-existent in Africa including Ethiopia. We aimed to adapt and validate the Breastfeeding Knowledge Questionnaire (BFKQ) and the Iowa Infant Feeding Attitude Scale (IIFAS) for use in Afan Oromo (AO), the most widely spoken language in Ethiopia. Methods: After forward-backward translation into Afan Oromo, the instruments were reviewed for content validity by a panel of a nutritionist and pediatricians, and pretested on a sample of 30 mothers. Then, a cross-sectional study involving 468 pregnant women in their second and third trimester was conducted between May and August 2017 in the Manna district, Southwest Ethiopia, using the final versions of the adapted questionnaires. We used exploratory and confirmatory factor analysis to assess the construct validity, receiver operating characteristic (ROC) curves to determine the predictive validity and Cronbach's alpha coefficients to assess internal consistency. Results: Using exploratory factor analysis (EFA), nine domains containing 34 items were extracted from the BFKQ-AO. A confirmatory factor analysis of the constructs from EFA confirmed construct validity of the instrument (χ2/ df = 2.11, RMSEA = 0.049, CFI = 0.845, TLI = 0.823). In factor analysis of the IIFAS, the first factor explained 19.7% of the total variance and the factor loadings and scree plot test suggested unidimensionality of the tool. Cronbach's alpha was 0.79 for the BFKQ-AO and 0.72 for IIFAS-AO suggesting an acceptable internal consistency of both instruments. For the sensitivity and specificity in predicting intention of breastfeeding for ≥24 months, the area under the curve (AUC) was 82% for IIFAS score and 79% for BFKQ score. Conclusions: Here we present the first study that reported the use of the BFKQ and the IIFAS in Ethiopia. Our results showed that both BFKQ-AO and IIFAS-AO can be reliable and valid tools for measuring maternal breastfeeding knowledge and attitude in the study population, showing the potential for adapting these tools for application in a wider Ethiopian context.

A cross-sectional comparison of breastfeeding knowledge, attitudes, and perceived partners’ support among expectant couples in Mekelle Ethiopia

“…In line with this study, previous studies have shown that maternal breastfeeding attitude was signi cantly correlated with the father's breastfeeding attitude score, indicating parents share similar breastfeeding attitudes [49,50]. The mean scores for mothers in this study were slightly lower but comparable (62 vs 65) with a recent study undertaken in southwest Ethiopia [41]. Positive attitudes towards breastfeeding determine maternal exclusive breastfeeding practice.…”

“…The questions are non-gendered and can be asked to men and women without modi cation. This tool has recently been validated in Ethiopia in the Afan Oromo language [41].…”

Breastfeeding Education and Support to Improve Early Initiation and Exclusive Breastfeeding Practices and Infant Growth: A Cluster Randomized Controlled Trial from a Rural Ethiopian Setting

“…Maternal knowledge and attitude towards breastfeeding were assessed using Afan Oromo (AO) versions of the Breastfeeding Knowledge Questionnaire (BFKQ) and the Iowa Infant Feeding Attitude Access Scale (IIFAS), which were culturally adapted and validated in the same population. Details of the adaptation process and psychometric properties of both tools are reported previously [28]. Both the BFKQ-AO and the IIFAS-AO had an acceptable level of internal consistency with Cronbach alpha values of 0.79 and 0.72, respectively.…”

Determinants of Knowledge and Attitude Towards Breastfeeding Using Validated Instruments in Pregnant Women From a Rural Setting in Ethiopia

“…Data were collected through a structured face-to-face interview after obtaining written consent from study participants. Maternal knowledge and attitude towards breastfeeding were assessed using the Afan Oromo versions of the Breastfeeding Knowledge Questionnaire (BFKQ-AO) and the IOWA Infant Feeding Attitude Scale (IIFAS-AO), which have been locally adapted and validated in the same population [30]. The BFKQ-AO consists of 34 items asking about various optimal breastfeeding practices, with responses coded as correct or incorrect.…”