Development, psychometric assessment, and predictive validity of the comprehensive breastfeeding knowledge scale

Clinically Integrated Breastfeeding Peer Counseling to Promote Breastfeeding Equity

OBJECTIVE

 This study aimed to determine whether clinically integrated Breastfeeding Peer Counseling (ci-BPC) added to usual lactation care reduces disparities in breastfeeding intensity and duration for Black and Hispanic/Latine participants.

STUDY DESIGN

 This study is a pragmatic, randomized control trial (RCT) of ci-BPC care at two ci-BPC-naïve obstetrical hospital facilities in the greater Chicago area. Participants will include 720 patients delivering at Hospital Site 1 and Hospital Site 2 who will be recruited from eight prenatal care sites during midpregnancy. Participants must be English or Spanish speaking, planning to parent their child, and have no exposure to ci-BPC care prior to enrollment. Randomization will be stratified by race and ethnicity to create three analytic groups: Black, Hispanic/Latine, and other races.

RESULTS

 The primary outcome will be breastfeeding duration. Additional outcomes will include the proportion of breastmilk feeds during the delivery admission, at 6-week postdelivery, and at 6-month postdelivery. A process evaluation will be conducted to understand implementation outcomes, facilitators, and barriers to inform replication and scaling of the innovative ci-BPC model.

CONCLUSION

This research will produce findings of relevance to perinatal patients and their families, the vast majority of whom desire to provide breastmilk to their infants and require support to succeed with their feeding goals. As the largest RCT of ci-BPC in the United States to date, this research will improve the quality of evidence available regarding the effectiveness of ci-BPC at reducing disparities. These findings will help patients and stakeholders determine the benefits of accepting and adopting the program and inform policies focused on improving perinatal care and reducing maternal/child health disparities. This study is registered with Clinical Trial (identifier: NCT05441709).

KEY POINTS

· Ci-BPC can promote racial breastfeeding equity.. · Ci-BPC has not been tested as a generalized lactation strategy in prior trials and is underused.. · This RCT will identify if ci-BPC can reduce breastfeeding disparities for Black and Hispanic patients..

Translation and validation of the Chinese version of the comprehensive breastfeeding knowledge scale (CBKS)

BACKGROUND

The level of breastfeeding knowledge of nursing students may influence their ability to support breastfeeding families. However, to date, it has not been possible to measure this accurately due to the lack of existence of a validated tool in Chinese.

OBJECTIVES

To translate the Comprehensive Breastfeeding Knowledge Scale (CBKS) into Chinese, and then evaluate its psychometric properties among Chinese undergraduate nursing students in order to inform and evaluate a nursing breastfeeding education programme.

METHODS

The Brislin translation model was followed, and a three-phase process (translation, back-translation and cultural adaptation) was used to sinicize the CBKS and evaluate its content validity. Construct validity was evaluated with exploratory factor analysis (EFA), and the reliability of internal consistency of the Chinese version of the CBKS was tested by calculating Cronbach's alpha coefficient and the half reliability coefficient.

SETTINGS

Two nursing schools in Beijing and Nanjing, China.

PARTICIPANTS

Four hundred and thirty-nine undergraduate nursing students (257 from Beijing and 182 from Nanjing).

RESULTS

Five experts rated the content validity of the Chinese version of the CBKS as excellent. EFA showed that the Chinese version of the CBKS had three subscales and 23 items. Cronbach's alpha coefficient of the Chinese version of the CBKS and the half reliability coefficient were 0.70 and 0.73, respectively. Students who had completed an obstetrics or paediatric nursing course had significantly higher total scores and mean scores for most items compared with those who had not taken a course. Most of the indictors of EFA met the standards of construct validity, and some were very close to the cut-off.

CONCLUSION

Overall, the 23-item Chinese version of the CBKS is an acceptable tool to measure the level of breastfeeding knowledge among undergraduate nursing students. This scale can be used to inform the design and evaluation of breastfeeding education materials for nursing students or other health profession students.

Workplace breastfeeding support for working women: A scale development study

Objective

In this study, authors aimed to develop a scale to evaluate workplace breastfeeding support.

Methods

The study was carried out with 490 working women who applied to the women's and children's outpatient clinics of a hospital in Turkey. The study data were collected by using a 'Personal Information Form' and the 'Workplace Breastfeeding Support for Working Women Draft Scale'. The data were analyzed on SPSS 25 and AMOS 21 software packages. In the development process of the scale; Content validity, exploratory factor analysis, item-total score correlation methods and Cronbach's Alpha coefficient were used.

Results

The content validity index of the scale was 0.90, and the Cronbach's alpha value was 0.93. Kaiser-Meyer-Olkin value of the scale was 0.91, Bartlett test values were χ2 = 11,573.924 and p < 0.000. According to the results of the exploratory factor analysis for the construct validity of the scale, the scale consisted of 31 items and 6 factors.

Conclusions

The developed scale can be used to evaluate workplace breastfeeding support for working women as a valid and reliable measurement tool.

The influence of bystander presence on evaluations of public breastfeeding among adults in the United States

BACKGROUND

In general, people tend to support private breastfeeding more than public breastfeeding, and discomfort surrounding public breastfeeding may contribute to sub-optimal rates of breastfeeding in the United States. Few studies have systematically examined situational factors that contribute to (negative) reactions to public breastfeeding. It is unclear whether the physical location or the presence of others is more influential in shaping people's evaluations of public breastfeeding. This study aimed to experimentally investigate the influence of location, bystander presence, bystander gender, and the breastfeeding woman's use of a cover on people's evaluations of breastfeeding images.

METHOD

A sample of adults residing in the United States was randomly assigned to view an image of a breastfeeding woman in an experimental study that examined four independent variables: breastfeeding location (public vs. private), bystander presence (present vs. not present), gender of bystander (male vs. female), and use of a cover (cover vs. no cover). Participants then reported their emotional reactions to, perceptions of, and behavioral intentions toward the breastfeeding woman. In addition, participants completed measures of sexism, traditional gender role endorsement, sexual comfort, body gaze, and breastfeeding knowledge and experience.

RESULTS

Hierarchical regressions revealed no differences between private and public breastfeeding images. Perceptions of the breastfeeding woman were more favorable when she was alone than with others, and when she was covered than when she was not covered. Evaluations tended to be more favorable among participants who scored lower on hostile sexism, higher on benevolent sexism, higher on sexual comfort, and higher on breastfeeding knowledge.

CONCLUSION

The presence of bystanders may be more consequential than the physical location in shaping reactions to public breastfeeding. These findings can be applied to improve support for public breastfeeding, which may contribute to higher breastfeeding rates and the associated public health benefits.

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

BACKGROUND

The evaluation of mothers' breastfeeding behaviour within 6 weeks postpartum could help health workers comprehensively identify maternal breastfeeding shortcomings, clarify nursing problems, and provide targeted interventions. However, no prior study was found, therefore this study aimed to develop and validate the reliability and validity of the mothers' breastfeeding behaviour scale within 6 weeks postpartum.

METHODS

A main two-step approach was used: (1) a qualitative pilot study using the purposive sampling method was adopted to test the 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 retest coefficients were 0.958, 0.843, and 0.753, respectively. The validity of the scale: (1) Content validity: content validity index (CVI) range of items was between 0.882 and 1.000. The scale-level-CVI was 0.990. (2) Structure validity: The fitting indices were as follows: χ²/ⅆf =2.239, RMR = 0.049, RMSEA = 0.069, TLI = 0.893, CFI = 0.903, IFI = 0.904, PGFI = 0.674, and PNFI = 0.763. (3) Convergent validity: The composite reliability and average variance extracted (AVE) of the seven dimensions were between 0.876 and 0.920 and between 0.594 and 0.696. (4) Distinguish validity: The correlation coefficients were less than the square root of the AVE, except for self-decision behaviour, self-coping behaviour, and self-control behaviour. However, the fit index of the original three-factor model was better than that of the 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 coefficients of the maternal breasting feeding evaluation scale, breastfeeding self-efficacy short-form scale, and the scale were 0.569 and 0.674, respectively.

CONCLUSION

The newly developed mothers' breastfeeding behaviour scale within 6 weeks postpartum consists of 36 items belonging to seven dimensions with good reliability and validity and is a reliable and valid instrument to be used in future maternal breastfeeding behaviour assessments and interventions.

Development and Validation of a Rating Scale of Pain Expression during Childbirth (ESVADOPA)

One of the most representative symptoms during childbirth is pain, which is one of the most prominent concerns of pregnant women. There are different instruments to assess pain, all of which require interrupting the woman, thus interfering with the intimacy of childbirth. This study seeks to develop and validate a rating scale of the expression of childbirth pain that does not require the mother’s attention and respects her privacy during labor. The study was conducted at a regional hospital in a border town in southern Spain between November 2018 and September 2019. Scale items were developed following a review of the scientific literature, and experts judged the content validity. After a pilot test, the scale was psychometrically evaluated. The psychometric tests consisted of internal consistency analysis, exploratory factor analysis, and determination of the content, construct, and convergent validity. The scale was evaluated by 36 experts in the field and was then applied to 55 women during the active phase of childbirth. The final version of the Rating Scale of Pain Expression during Childbirth (in Spanish, Escala de Valoración de la Expresión del Dolor durante el Trabajo de Parto—ESVADOPA) consists of six items in two dimensions. The scale had a Cronbach’s alpha coefficient of 0.78, and the content validity measured by Aiken’s V co-efficient was also 0.78. The exploratory factor analysis yielded two dimensions that explained 68.08% of the total variance. For convergent validity, a comparison was made with the visual analogue scale, yielding a medium–high value of 0.641. As indicated by the internal consistency and by the content and construct validity outcomes, the ESVADOPA successfully measures pain expression during childbirth and represents a suitable tool for pain expression during birth without the need for intervention or the need for the mother to speak the same language as the midwife.

The comparison of access to an eHealth resource to current practice on mother and co-parent teamwork and breastfeeding rates: A randomized controlled trial

BACKGROUND

Breastfeeding rates are suboptimal, putting mothers and their infants' health at risk. One modifiable risk factor amenable to intervention is partner support. Having women work as a team with their co-parents to meet their breastfeeding goals has been found to improve breastfeeding outcomes. eHealth resources have been found to be accessible and feasible ways to provide breastfeeding education yet, the best way to design breastfeeding interventions for mothers and their co-parents is not known.

OBJECTIVES

To compare two study conditions to determine: (1) which way is more effective to provide breastfeeding education to women and their co-parents on increasing breastfeeding rates and associated secondary outcomes, such as breastfeeding knowledge, attitude, self-efficacy and overcoming challenges; (2) the difference in co-parenting and partner support between the study groups; (3) how parents in both groups preferred to access breastfeeding information; and (4) the groups' satisfaction with the eHealth resource that was provided.

DESIGN

This study used a randomized controlled trial design (Clinicaltrials.org #NCT03492411). Participants were randomly allocated to study groups with concealed opaque envelopes by a blinded research assistant. Participants in Study Condition #1 (SC1) accessed a previously created, online e-Health resource, in addition to other generally available resources they could access in the community; participants in Study Condition #2 (SC2) accessed only the generally available resources.

SETTING

Participants were recruited in health care providers' offices and services for expectant parents in Ontario and via social media throughout Canada.

PARTICIPANTS

Expectant women (n = 113) and their co-parents (n = 104) were enrolled.

METHODS

After eligibility was determined, consents obtained and baseline surveys completed, group allocation was conducted. SC1 had a virtual meeting with a research assistant to review the eHealth resource. Weekly emails were sent to all participants for 6 weeks as reminders. Follow-up data were electronically collected from mothers and co-parents at 2 weeks post enrollment and 4, 12, 26 and 52-weeks postpartum.

RESULTS

Breastfeeding rates were high in both groups (SC1 63% and SC2 57% 'exclusive' 6 months) and (SC1 71% and SC2 78% 'any' 12 months) and not statistically significantly different. High scores were found in both groups in secondary outcome measures. Generally available breastfeeding resources were used in both groups with websites being used often and rated as most helpful. SC1 rated the eHealth resource provided to them highly.

CONCLUSION

The findings suggest both mothers and their co-parents should be targeted in breastfeeding education and web-based resources designed to meet their needs.