The Spanish version of the Prenatal Breast-feeding Self-efficacy Scale: Reliability and validity assessment

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Abstract

Background

Only a minority of infants are exclusively breastfed for the recommended 6 months postpartum. Breast-feeding self-efficacy is a mother's confidence in her ability to breastfeed and is predictive of breastfeeding behaviors. The Prenatal Breast-feeding Self-efficacy Scale (PBSES) was developed among English-speaking mothers to measure breastfeeding self-efficacy before delivery.

Objectives

To translate the PBSES into Spanish and assess its psychometric properties.

Design

Reliability and validity assessment.

Setting

A public hospital in Yecla, Spain.

Participants

A convenience sample of 234 pregnant women in their third trimester of pregnancy.

Methods

The PBSES was translated into Spanish using forward and back translation. A battery of self-administered questionnaires was completed by participants, including a questionnaire on sociodemographic variables, breastfeeding experience and intention, as well as the Spanish version of the PBSES. Also, data on exclusive breastfeeding at discharge were collected from hospital database. Dimensional structure, internal consistency and construct validity of the Spanish version of PBSES were assessed.

Results

Confirmatory factor analysis suggested the presence of one construct, self-efficacy, with four dimensions or latent variables. Cronbach's alpha coefficient for internal consistency was 0.91. Response patterns based on decision to breastfeed during pregnancy provided evidence of construct validity. In addition, the scores of the Spanish version of the PBSES significantly predicted exclusive breastfeeding at discharge.

Conclusions

The Spanish version of PBSES shows evidences of reliability, and contrasting group and predictive validity. Confirmatory factor analysis indicated marginal fit and further studies are needed to provide new evidence on the structure of the scale. The Spanish version of the PBSES can be considered a reliable measure and shows validity evidences.

Introduction

Breastfeeding is the most natural and healthiest way to feed a child during early life due to its substantial short and long term health benefits for mothers, infants and young children (Gartner et al., 2005).

The World Health Organization recommends exclusive breastfeeding during the first 6 months of life, and continued breastfeeding with adequate complementary foods until at least 2 years of age. However, despite these recommendations, only a minority of infants are breastfed in Spain and Europe (Cattaneo et al., 2005, Oliver-Roig et al., 2011).

Breastfeeding self-efficacy is the confidence a mother has in her ability to breastfeed her child. It is influenced by previous breastfeeding experience, contact with other mothers who have breastfed, family and professional support and the mother's physical condition during breastfeeding (Bandura, 1986, Dennis, 2006). Breastfeeding self-efficacy has been related to the decision to initiate breastfeeding and with its duration (Meedya et al., 2010). As most women decide on their infant feeding method antenatally, interventions aimed to improve their breastfeeding self-efficacy during pregnancy could be useful to promote breastfeeding. A prenatal breastfeeding self-efficacy evaluation could be useful to develop and evaluate these interventions. However, there are no Spanish instruments to evaluate breastfeeding self-efficacy prior to birth. Only an instrument evaluating breastfeeding self-efficacy has been adapted into Spanish context (Oliver-Roig et al., 2011), but it is developed for women after birth.

The Prenatal Breast-feeding Self-efficacy Scale (PBSES) was developed by Wells et al. (2006) and it was designed to assess the level of breastfeeding self-efficacy prior to birth. There is evidence that the English version of the PBSES is a sufficiently reliable and valid tool for evaluating breastfeeding self-efficacy. The purpose of this study is to translate the PBSES into Spanish and to assess its psychometric properties among Spanish pregnant women.

Section snippets

Participants

A convenience sample of 234 pregnant women was recruited from a regional hospital in Yecla, Spain, a public hospital with the Baby-friendly Hospital Initiative award since 2004. All participants were able to read and write in Spanish and they were in their third trimester of pregnancy. Multiple-pregnancy mothers (higher difficulties in breastfeeding) and those who were known to be infected with human immunodeficiency virus or with other contraindication to breastfeeding were excluded from the

Description of sample

The mean age of the sample was 30.49 years (SD = 4.7, range 16–44). The majority were married, primiparous and had decided to breastfeed in the postpartum (Table 1). We obtained data on breastfeeding at discharge from 91.2% (n = 202) of mothers, 81.2% (n = 164) of which were exclusively breastfeeding.

Semantic equivalence

None of the 20 items on the scale was considered inappropriate for the Spanish context. It was not necessary to make any changes to 11 of the items. Meanwhile, expressions that were more fitting to the

Discussion

The translation process was systematic and rigorously conducted to ensure that equivalence was established.

Confirmatory factor analysis indicated marginal model fit for model 1. GFI was high and SRMR and RMSEA values also suggested an acceptable fit to the data. The χ2/DF and CFI did not show data fit according to the standard recommendations. On the other hand, our data did not fit to a one-factor model (model 2). Model 1, including the 2 independent items found in the original study in those

Conclusion

This is the first prenatal breastfeeding self-efficacy survey using the Spanish version of PBSES (PBSES-e). Most of the results of this study are similar to original study.

Confirmatory factor analysis suggested the presence of one construct, self-efficacy, with four dimensions or latent variables. Partial scores for each dimension and a total summed score can be calculated.

PBSES-e scores are related with lactation decision during pregnancy and predict exclusive breastfeeding at discharge.

Acknowledgments

The authors would like to thank Verónica Muñoz Soler for her collaboration in obtaining clinical data.

Conflicts of interest: The investigators do not benefit from subject's participation in the study or completion of this project.

Funding: This research was supported by grants from the Foundation for Health Research and Training in the region of Murcia (Spain) (EMCA 08/14) and from the Ministry of Science and Innovation of Spain (PI09/90899). The funders had no part in collecting, analyzing or

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