The mothers' breastfeeding behavior within six weeks postpartum: new scale development and psychometric validation study

Abstract

Background: The evaluation of mothers' breastfeeding behavior within six weeks postpartum could help health workers to identify maternal breastfeeding shortcomings comprehensively, clarify nursing problems, and provide targeted interventions. However, no prior study was found and the study aimed to develop and validate the reliability and validity of mothers' breastfeeding behavior scale within six weeks postpartum.Methods: The main two-step approach was used: (1) A qualitative pilot study using the purposive sampling method was adopted to test fitness, simplicity, and clarity of items with 30 mothers; (2) A cross-sectional survey using the convenient sampling method was conducted for item analysis and psychometric validation with 600 mothers.Results: The final version of the scale consisted of 36 items with seven dimensions, explaining 68.852% of the total variance. The Cronbach's α, split-half, and re-test coefficients were 0.958, 0.843, and 0.753, respectively. The validity of the scale: (1) Content validity: The content validity indexes (CVI) range of items were between 0.882 and 1.000. The scale-level-CVI was 0.990. (2) Structure validity: The fitting index were as follows: =2.239, RMR=0.049, RMSEA=0.069, TLI=0.893, CFI=0.903, IFI=0.904, PGFI=0.674, PNFI=0.763. (3) Convergent validity: The composite reliability and Average Variance Extraction (AVE) of 7 dimensions were between 0.876 and 0.920, 0.594 and 0.696. (4) Distinguish validity: The correlation coefficients were less than the square root of the AVE, excepting self-decision behavior, self-coping behavior, and self-control behavior. However, the fitting index of the original three-factor model was better than other new models with significant differences (P<0.001). (5) Calibration validity: The area under the curve was 0.860 or 0.898 when the scale was used to predict exclusive or any breastfeeding at 42 days. The correlation coefficient of maternal breasting feeding evaluation scale, breastfeeding self-efficacy short-form scale, and the scale were 0.569 and 0.674.Conclusion: The newly developed mothers' breastfeeding behavior scale within six weeks postpartum consists of thirty-six items belonging to seven dimensions with good reliabilities and validities, a reliable and valid instrument to be used in future maternal breastfeeding behavior assessments and interventions.