Development of an instrument designed to measure employees' perceptions of workplace breastfeeding support

Psychometric Properties of the Breastfeeding and Employment Scale

OBJECTIVE

To evaluate the psychometric properties of the Breastfeeding and Employment Scale (BES).

DESIGN

Secondary analysis of data from the Infant Feeding Practices Study II survey, a longitudinal study on infant feeding practices.

SETTING

United States.

PARTICIPANTS

Women who were employed, breastfeeding, and completed the Infant Feeding Practices Study II BES at the 3-month postpartum assessment (N = 508).

METHODS

Participants reported their perceived level of breastfeeding support in the workplace by responding to the nine binary items on the BES. We evaluated the instrument's internal consistency reliability (Kuder-Richardson 20), test-retest reliability (Cohen's kappa), construct validity (principal component analysis), and convergent validity (relationship with a similar item).

RESULTS

The internal consistency of the BES (Kuder-Richardson 20 = 0.72) supported the reliability of scale. The test-retest reliability was moderate (0.41-0.60). The Spearman's rho correlation coefficient was 0.66, indicating adequate test-rest reliability for the total BES score between the 3-month and 6-month assessments (p < .01). The factor analysis demonstrated that the items cluster into one factor (psychosocial and structural barriers to breastfeeding in the workplace). Participants who reported more barriers to breastfeeding in the workplace also reported a less supportive workplace environment, which supported the convergent validity of the scale.

CONCLUSION

The psychometric testing of the BES provided initial support for the reliability and validity of the instrument. It may be a useful tool for measuring workplace lactation support in a concise manner.

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.

Workplace Breastfeeding Support and Breastfeeding Practices among Healthcare Professionals

Introduction

Working mothers face striking challenges in breastfeeding. It is important to focus on them to further improve breastfeeding rates.

Aim and Objectives

To assess the workplace breastfeeding support and breastfeeding practices of healthcare professionals.

Methodology

We conducted a cross-sectional study among two hospitals in East Delhi. All mothers having at least one child aged six months to five years and currently employed as healthcare personnel were included. For a sample size of 100, population proportionate to size sampling was done among two hospitals. The participants were randomly selected from a list of healthcare personnel. Employee perception of breastfeeding support questionnaire (EPBS-Q) was used to assess the workplace breastfeeding support. Chi-square test was used to compare proportions, logistic regression, and survival analysis to find the association between workplace breastfeeding support and IYCF parameters.

Results

The proportion of mother who perceived poor workplace breastfeeding support was 37%. The mean (SD) score obtained was 103.48 (8.93). The early initiation of breastfeeding within one hour was practiced by 54%, exclusive breastfeeding for at least six months by 60%, and timely initiation of complementary feeding for six to eight months by 64% mothers. Workplace breastfeeding support was significantly associated with exclusively breastfeeding for at least six months.

Conclusions

More than one-third of mothers perceived poor workplace breastfeeding, and it was associated with exclusive breastfeeding.

Breastfeeding in the Workplace: Attitudes Toward Multiple Roles, Perceptions of Support, and Workplace Outcomes

Objective: American women are consistently tasked with breastfeeding, while returning to work, but little research examines how women perceive support in the workplace and their own working outcomes. This study examined the associations among breastfeeding women's perceptions of breastfeeding support in the workplace (i.e., managerial, organizational, co-worker, time, and physical environment), attitudes toward multiple roles, and workplace outcomes (i.e., affective commitment, job satisfaction, and workplace productivity). Materials and Methods: Survey data from 109 mothers who have or are currently breastfeeding/pumping human milk at their workplace were collected and analyzed. Results: Results indicated significant positive relationships among attitudes toward multiple roles and workplace productivity. In addition, perceptions of breastfeeding support were significantly associated with both affective commitment as well as job satisfaction. Finally, our sample of breastfeeding employees returned to work after having a baby primarily for financial reasons, and do not generally feel very supported in the workplace. Conclusions: Overall, organizations can promote more investment and satisfaction in employees by providing explicit communication about breastfeeding-supportive policies to all employees. These findings underscore the importance of organizational breastfeeding support for mothers as well as their coworkers, which ultimately influences the success of the organization as a whole.

Development of the breastfeeding support scale to measure breastfeeding support from lay and professional persons, and its predictive validity in Japan

Background

International and national organizations recommend exclusive breastfeeding for the first 6 months of life, but many women stop earlier. Lay and professional persons can support mothers’ efforts to overcome breastfeeding difficulties. Considering breastfeeding support to comprise emotional support, practical help, and information offered to women who desire to breastfeed (by professionals, family members, and others), we developed and tested a scale to measure it in Japan.

Methods

A total of 31 items were generated by literature review and from the authors’ clinical experiences. Those items were tested with 243 mothers who visited public health centers in Tokyo for their infant’s health check-up 3 months after birth. Breastfeeding support and infant feeding status were then assessed 5 months after birth. All the data were collected by using self-administered questionnaires.

Results

On the basis of the results of factor analysis, the number of items was reduced to 11. There were three factors: support from breastfeeding peers and from people in specifically named healthcare professions, practical help, and support from people the mother can rely on to help meet emotional needs and address breastfeeding concerns. Internal-consistency reliability (alpha) of scores on the 11-item scale was 0.83 when measured 3 months postpartum and 0.85 when measured 5 months postpartum. Higher scores on the 11-item scale 3 months postpartum were associated with more breastfeeding exclusivity both at that time (Kruskal–Wallis test, chi-squared = 14.871, df = 3, n = 211, p = 0.002, eta-squared = 0.071) and also 5 months postpartum (Kruskal–Wallis test, chi-squared = 8.556, df = 3, n = 159, p = 0.036, eta-squared = 0.054). Further, the area under the Receiver Operating Characteristic curve was 0.73 (95% CI [0.57–0.88]), which indicates that scores on the 11-item scale 3 months postpartum may be useful to predict which mothers will be less exclusive in breastfeeding 5 months postpartum. In conclusion, scores on this 11-item scale were reasonably reliable and valid for measuring breastfeeding support provided by lay and professional persons to mothers in Japan. Further research is required to evaluate this scale’s applicability in other settings.

Workplace Lactation Support: Using Implementation Climate to Inform a New Model

Introduction: Breastfeeding (BF) duration remains problematic, especially among women returning to work. Given that use of workplace lactation support programs has not gained traction in improving BF duration, there appears to be elements missing from lactation support initiatives that need further exploration. The field of Implementation Science, in explaining organizational behavior, provides an opportunity to inform a better model for workplace BF support. Materials and Methods: To inform a new model for workplace lactation support, data from the Breastfeeding and Employment Study (BESt) were combined with Implementation Climate theory. BESt surveyed companies on their BF supports, and used hierarchical linear modeling to determine the association of those supports with company employee perceptions of and manager attitudes toward BF supports. Results: Employee scores were not associated with any company scores. Total company scores were associated with more positive manager attitudes (p < 0.01), due to structural supports, or those supports most visible to managers. Considering these results along with other studies, it is proposed that employees and managers are influenced by tangible (physical) as well as intangible (people) workplace lactation supports. Furthermore, strategies are needed to design and implement approaches to these components to increase workplace lactation support and improve BF durations. Conclusions: Implementation strategies will vary with the diversity of workplaces and how they function. A better understanding of the application of implementation climate for workplace lactation support will help tailor programs and their implementation to improve BF duration in employed women.

Impact of Key Workplace Breastfeeding Support Characteristics on Job Satisfaction, Breastfeeding Duration, and Exclusive Breastfeeding Among Health Care Employees

Background: Although national breastfeeding rates have improved across recent decades, women continue to face barriers to achieving recommended breastfeeding targets. Returning to work presents a unique set of challenges for breastfeeding continuation, even in health care settings tasked with promoting breastfeeding among patients. This study examined the association between key workplace breastfeeding support characteristics, job satisfaction, and breastfeeding outcomes among health care employees. Materials and Methods: We used data from a cross-sectional survey of employees in a large integrated health care system. The study sample included female employees who had breastfed in the past 3 years (n = 165). The Employee Perceptions of Breastfeeding Support Questionnaire (EPBS-Q) measured organization, manager, and coworker support for breastfeeding. Regression analyses tested the association between workplace support factors and breastfeeding duration, breastfeeding exclusivity, and job satisfaction. Results: Managerial support increased median job satisfaction by 0.39 standard deviations (p < 0.001), and increased the odds of prolonging exclusive breastfeeding (odds ratio [OR] 1.47; confidence interval [CI] 1.03-2.09). Organizational support increased median job satisfaction by 0.27 standard deviations (p < 0.001), and increased the odds of exclusive breastfeeding by nearly twofold (OR 1.80; CI 1.05-3.09). No significant associations were found between workplace support factors (organizational, managerial, and co-worker support) and overall breastfeeding duration. Conclusions: Organizational and managerial support are key aspects of workplace lactation support, which may positively impact job satisfaction, rates of exclusive breastfeeding, and duration of exclusive breastfeeding among female health care employees. This intersection of outcomes salient for the business community and public health practitioners highlights opportunities for collaborations to improve workplace and breastfeeding outcomes.

Impact of an Infant Friendly Business Designation

In response to suboptimal breastfeeding rates, North Dakota added a provision to SB 2344 (public indecency legislation) creating an Infant Friendly business designation for employers providing specified lactation accommodations to employees. However, there has been no evaluation of this designation to determine effectiveness. The purpose of this article is to examine the impact of the Infant Friendly business designation in North Dakota on breastfeeding continuation rates within the context of the social ecological model (SEM). Between November 2016 and March 2017, an 85-item online questionnaire, designed using the SEM, was distributed to working women across the state using various sampling methods. T tests, analysis of variance, and regression were used to analyze results. Designated (intervention) and nondesignated (control) businesses were targeted. There was no statistically significant difference in breastfeeding duration between designated and nondesignated businesses. There was a 2-month difference in duration between continually designated businesses and those with lapsing designations. Twenty-eight percent of the women working for Infant Friendly businesses were aware that their businesses were designated, indicating a lack of awareness regarding the designation. The designation is a starting point for worksite breastfeeding support. A policy promotion plan based on the SEM targeting individual awareness and employee education may improve the designation's effectiveness.

Breastfeeding Support in the Workplace: The Relationships Among Breastfeeding Support, Work-Life Balance, and Job Satisfaction

BACKGROUND

Women are increasingly faced with decisions about how to combine breastfeeding with work, but few researchers have directly measured how breastfeeding relates to the work-life interface. Research aim: The authors examined how perceptions of work enhancement of personal life and work interference with personal life were influenced by workplace breastfeeding support, including organizational, manager, and coworker support, as well as adequate time to express human milk. Then, we examined how workplace breastfeeding support predicted work-life variables and job satisfaction.

METHODS

Using a self-report, survey design, the authors analyzed online surveys from 87 women in a rural, community sample who indicated that they had pumped at work or anticipated needing to pump in the future.

RESULTS

According to regression results, provision of workplace breastfeeding support, particularly providing adequate time for human milk expression, predicted work enhancement of personal life. Conversely, we found that as workplace support diminished, employees perceived greater work interference with personal life. Results of path analysis further suggested that providing time for expressing milk improved job satisfaction via a partially mediated relationship where work enhancement of personal life acted as a mediator.

CONCLUSION

These results suggest that employers can enhance the lives of their breastfeeding employees both at work and at home by providing workplace breastfeeding support, especially through providing time for expressing human milk in the workplace.

A Critical Review of Instruments Measuring Breastfeeding Attitudes, Knowledge, and Social Support

BACKGROUND

Breastfeeding provides beneficial health outcomes for infants and their mothers, and increasing its practice is a national priority in many countries. Despite increasing support to exclusively breastfeed, the prevalence at 6 months remains low. Breastfeeding behavior is influenced by a myriad of determinants, including breastfeeding attitudes, knowledge, and social support. Effective measurement of these determinants is critical to provide optimal support for women throughout the breastfeeding period. However, there are a multitude of available instruments measuring these constructs, which makes identification of an appropriate instrument challenging. Research aim: Our aim was to identify and critically examine the existing instruments measuring breastfeeding attitudes, knowledge, and social support.

METHODS

A total of 16 instruments was identified. Each instrument's purpose, theoretical underpinnings, and validity were analyzed.

RESULTS

An overview, validation and adaptation for use in other settings was assessed for each instrument. Depth of reporting and validation testing differed greatly between instruments.

CONCLUSION

Content, construct, and predictive validity were present for most but not all scales. When selecting and adapting instruments, attention should be paid to domains within the scale, number of items, and adaptation.

Relationship of maternal perceptions of workplace breastfeeding support and job satisfaction

OBJECTIVES

Decades of research supports the health benefits of breastfeeding. Prior research has shown that unsupportive work environments are frequently cited as reasons women abandon breastfeeding early. The objective of this study is to determine if mothers' perceptions of workplace lactation support are associated with job satisfaction.

MATERIALS AND METHODS

Female employees of Seattle Children's Hospital (SCH) and a large corporation were e-mailed a survey to measure perceptions of workplace lactation support. Women were eligible to participate if they had a child born within the last 5 years. Questions were asked about lactation support across five domains; organization, manager, coworker, time, and physical environment. The main outcome was job satisfaction. Linear regression models were run to evaluate the association between workplace support scores and the outcome of interest.

RESULTS

The survey was completed by 420 women at SCH and 131 women at the large corporation (response rate, 47%). Ninety-eight percent of study participants initiated breastfeeding, and most sustained breastfeeding for at least 6 months. Increased total workplace support score was associated with increased job satisfaction at both companies (p<0.001). Increased support scores within each domain were independently associated with increased job satisfaction (p values<0.005). When all domains were considered together, only manager and coworker supports were significant at SCH (p=0.04), and only time support was significant at the large corporation (p=0.01). The workplace support score was not significantly associated with breastfeeding duration at either institution.

CONCLUSIONS

Improved lactation support in the workplace may improve new mothers' job satisfaction, which could be beneficial to businesses.