Psychometric Assessment of the Paternal Breastfeeding Self-Efficacy Scale-Short Form: A Confirmatory Factor Analysis of Malawian Fathers

Abstract

Background:

Only 61% of Malawian women exclusively breastfeed to the recommended 6 months. Paternal support is predictive of exclusive breastfeeding, and significantly related to paternal breastfeeding self-efficacy, defined as fathers’ confidence in their ability to assist mothers with breastfeeding.

Research Aims:

To (1) examine the psychometric properties of the Paternal Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) in Malawian fathers, including internal consistency reliability, test-retest reliability, construct validity using Confirmatory Factor Analysis (CFA), and convergent validity; and (2) assess the relationship between the BSES-SF and paternal demographic and health factors.

Methods:

A cross-sectional study was conducted at a maternity hospital in Lilongwe, Malawi, and 180 fathers whose partners had delivered a singleton infant were included. Participants completed the Breastfeeding Self-Efficacy Scale and Quality of Life with confirmatory factor analysis performed to assess the construct validity. The internal consistency reliability and test-retest reliability were evaluated using Cronbach’s alpha coefficient and intra-class correlations. Convergent validity was also assessed.

Results:

A unidimensional factorial structure of the Malawian Paternal BSES-SF was identified using confirmatory factor analysis. The scale had an excellent Cronbach’s alpha of .90 and a test-retest reliability of .93. Participants’ breastfeeding self-efficacy was significantly correlated with the Quality of Life domains of psychological health (r = .23; p < .01), social relationships (r = .28; p < .001), and environmental health (r = .30; p < .001). Participants who were older, married, and with ≥ two children had significantly higher breastfeeding self-efficacy and were more confident in their ability to support their partner’s breastfeeding.

Conclusion:

The Paternal Breastfeeding Self-Efficacy Scale-Short Form was a valid and reliable measure to assess fathers’ confidence in their ability to assist mothers with breastfeeding in Malawi.

Keywords

breastfeeding fathers Malawi Paternal Breastfeeding Self-Efficacy Scale-Short Form reliability self-efficacy validity

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References

Abbass-Dick

Stern

S. B.

Nelson

L. E.

Watson

Dennis

C. L.

(2015). Coparenting breastfeeding support and exclusive breastfeeding: A randomized controlled trial. Pediatrics, 135(1), 102–110. https://doi.org/10.1542/peds.2014-1416

Al Namir

H. M. A.

Brady

A.-M.

Gallagher

. (2017). Fathers and breastfeeding: Attitudes, involvement and support. British Journal of Midwifery, 25(7), 426–440. https://doi.org/10.12968/BJOM.2017.25.7.426

Black

W. C.

Babin

B. J.

Anderson

R. E.

(2010). Multivariate data analysis: A global perspective. Pearson Education.

Bujang

M. A.

Baharum

(2017). A simplified guide to determination of sample size requirements for estimating the value of intraclass correlation coefficient: A review. Archives of Orofacial Science, 12(1), 1–11.

Cai

Wardlaw

Brown

D. W.

(2012). Global trends in exclusive breastfeeding. International Breastfeeding Journal, 7(1), 12. https://doi.org/10.1186/1746-4358-7-12

Campbell

O. M.

Cegolon

Macleod

Benova

(2016). Length of stay after childbirth in 92 countries and associated factors in 30 low- and middle-income countries: Compilation of reported data and a cross-sectional analysis from nationally representative surveys. PLoS Medicine, 13(3), e1001972. https://doi.org/10.1371/journal.pmed.1001972

Chipojola

Lee

G. T.

Chiu

H.-Y.

Chang

P.-C.

Kuo

S.-Y.

(2020). Determinants of breastfeeding practices among mothers in Malawi: A population-based survey. International Health, 12(2), 132–141. https://doi.org/10.1093/inthealth/ihz034

Chisenga

J. Z.

Chalanda

Ngwale

(2015). Kangaroo mother care: A review of mothers’ experiences at Bwaila hospital and Zomba Central hospital (Malawi). Midwifery, 31(2), 305–315. https://doi.org/10.1016/j.midw.2014.04.008

Colbourn

Masache

Skordis-Worrall

(2012a). Development, reliability and validity of the Chichewa WHOQOL-BREF in adults in Lilongwe, Malawi. BMC Research Notes, 5(1), 1–11. https://doi.org/10.1186/1756-0500-5-346

10.

Colbourn

Masache

Skordis-Worrall

(2012b). Development, reliability and validity of the Chichewa WHOQOL-BREF in adults in Lilongwe, Malawi. BMC Research Notes, 5(1), 346. https://doi.org/10.1186/1756-0500-5-346

11.

Dennis

C. L.

(2003). The breastfeeding self-efficacy scale: Psychometric assessment of the short form. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 32(6), 734–744. https://doi.org/10.1177/0884217503258459

12.

Dennis

C. L.

(2006). Identifying predictors of breastfeeding self-efficacy in the immediate postpartum period. Research in Nursing & Health, 29(4), 256–268. https://doi.org/10.1002/nur.20140

13.

Dennis Brennenstuhl

Abbass-Dick

. (2018). Measuring paternal breastfeeding self-efficacy: A psychometric evaluation of the Breastfeeding Self-Efficacy Scale-Short Form among fathers. Midwifery, 64, 17–22. https://doi.org/10.1016/j.midw.2018.05.005

14.

Dennis

C. L.

Faux

(1999). Development and psychometric testing of the Breastfeeding Self-Efficacy Scale. Research in Nursing & Health, 22(5), 399–409. https://doi.org/10.1002/(sici)1098-240x(199910)22:5<399::aid-nur6>3.0.co;2-4

15.

Jennings

M. J.

Zumbo

B. D.

Joula

J. F.

(2002). The robustness of validity and efficiency of the related samples t-test in the presence of outliers. Psicologica, 23(2), 415–450.

16.

Kavle

J. A.

Welch

P. R.

Bwanali

Nyambo

Guta

Mapongo

Straubinger

Kambale

(2019). The revitalization and scale-up of the Baby-Friendly Hospital Initiative in Malawi. Maternal & Child Nutrition, 15, e12724. https://doi.org/10.1111/mcn.12724

17.

Kline

(2011). Principles and practice of structural equation modeling (3rd ed.). Guilford.

18.

Koo

T. K.

M. Y.

(2016). A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of Chiropractic Medicine, 15(2), 155–163. https://doi.org/10.1016/j.jcm.2016.02.012

19.

Ministry of Health and Population. (2020). Infant and Young Child Nutrition Policy and Guidelines. https://www.resakss.org/sites/default/files/Malawi%20MHP%202003%20Infant%20and%20Young%20Child%20Nutrition%20Policy%20and%20Guidelines%202003%20-%20.

20.

Mirghafourvand

Kamalifard

Ranjbar

Gordani

(2018). Relationship of breastfeeding self-efficacy with quality of life in Iranian breastfeeding mothers. The Journal of Maternal-Fetal & Neonatal Medicine, 31(20), 2721–2728. https://doi.org/10.1080/14767058.2017.1354368

21.

Mlungwana

(2020). An African approach to the meaning of life. South African Journal of Philosophy, 39(2), 153–165. https://doi.org/10.1080/02580136.2020.1771824

22.

National Statistical Office/Malawi & ICF. (2017). Malawi Demographic and Health Survey 2015–16. https://dhsprogram.com/pubs/pdf/FR319/FR319.pdf

23.

Nortjé

Albertyn

(2015). The cultural language of pain: A South African study. South African Family Practice, 57(1), 24–27. https://doi.org/10.1080/20786190.2014.977034

24.

Nukpezah

R. N.

Nuvor

S. V.

Ninnoni

(2018). Knowledge and practice of exclusive breastfeeding among mothers in the tamale metropolis of Ghana. Reproductive Health, 15(1), 1–9. https://doi.org/10.1186/s12978-018-0579-3

25.

Palk

Okano

J. T.

Dullie

Blower

(2020). Travel time to health-care facilities, mode of transportation, and HIV elimination in Malawi: A geospatial modelling analysis. The Lancet Global Health, 8(12), e1555–e1564. https://doi.org/10.1016/S2214-109X(20)30351-X

26.

Phillips

(2018). Survey of African marriage and family life. Routledge.

27.

Simon

Kriston

Loh

Spies

Scheibler

Wills

Härter

(2010). Confirmatory factor analysis and recommendations for improvement of the Autonomy-Preference-Index (API). Health Expectations, 13(3), 234–243. https://psycnet.apa.org/doi/10.1037/t03059-000

28.

Swisher

L. L.

Beckstead

J. W.

Bebeau

M. J.

(2004). Factor analysis as a tool for survey analysis using a professional role orientation inventory as an example. Physical Therapy, 84(9), 784–799. https://doi.org/10.1093/ptj/84.9.784

29.

Tabachnick

B. G.

Fidell

L. S.

(2001). Principal components and factor analysis. Using Multivariate Statistics, 4, 582–633. https://doi.org/10.1016/j.csda.2020.107164

30.

Taber

K. S.

(2018). The use of Cronbach’s alpha when developing and reporting research instruments in science education. Research in Science Education, 48(6), 1273–1296. https://doi.org/10.1007/s11165-016-9602-2

31.

Tavakol

Dennick

(2011). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53–55. https://doi.org/0.5116/ijme.4dfb.8dfd

32.

Tinsley

H. E.

Tinsley

D. J.

(1987). Uses of factor analysis in counseling psychology research. Journal of Counseling Psychology, 34(4), 414. https://psycnet.apa.org/doi/10.1037/0022-0167.34.4.414

33.

Wild

Grove

Martin

Eremenco

McElroy

Verjee-Lorenz

Erikson

(2005). Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation. Value in Health, 8(2), 94–104. https://doi.org/10.1111/j.1524-4733.2005.04054.x

34.

World Health Organization. (2008). Indicators for assessing infant and young child feeding practices. Part 1: Definitions – Conclusions of a consensus meeting held 6–8 November 2007 in Washington DC, USA. https://apps.who.int/iris/handle/10665/43895?locale-attribute=en&

35.

World Health Organization. (1996). WHOQOL-BREF: Introduction, administration, scoring and generic version of the assessment: Field trial version, December 1996. https://www.who.int/mental_health/media/en/76.pdf