The Breastfeeding Self-Efficacy Scale–Short Form (BSES-SF): German Translation and Psychometric Assessment

Abstract

German

Background:

German-speaking mothers have breastfeeding rates below the international breastfeeding recommendations. Previous research has found that breastfeeding self-efficacy is an important and modifiable predictor of breastfeeding outcomes, thus improving breastfeeding rates. The Breastfeeding Self-Efficacy Scale–Short Form (BSES-SF) is used in many countries to assess maternal breastfeeding self-efficacy. This instrument has not been available in German.

Research Aims:

To translate the BSES-SF into German and assess its psychometric properties among breastfeeding mothers up to 12 weeks postpartum.

Methods:

This cross-sectional study was conducted online with 355 breastfeeding mothers recruited from breastfeeding groups through Facebook. The BSES-SF was translated into German using forward and back-translation. To test reliability, item-total characteristics, including Cronbach’s alpha, were examined. We used principal component analysis, as well as known-groups comparisons for evaluating construct validity, and examined the relationship between breastfeeding self-efficacy and demographic variables.

Results:

The mean age of participants was 32.4 years (SD = 4.32). The Cronbach’s alpha coefficient was .88 and corrected item-total correlations ranged between .37 and .73. Principal components analysis yielded one component with factor loadings >.40 and an eigenvalue of 5.62, which explained 40% of the total variance. In addition, known group comparisons provided further evidence for construct validity. There was no significant difference in BSES-SF scores in terms of demographic and obstetrics characteristics.

Conclusion:

Our results provide evidence that the German version of the BSES-SF is a reliable and valid tool for measuring breastfeeding self-efficacy among mothers in German-speaking countries.

Keywords

breastfeeding Breastfeeding Self-Efficacy Scale Short – Form,German version maternal psychology psychometric assessment translation

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References

Abou-Dakn

(2018). Gesundheitliche Auswirkungen des Stillens auf die Mutter [Health effects of breastfeeding on the mother]. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 61(8), 986–989. https://doi.org/10.1007/s00103-018-2776-1

American Academy of Pediatrics Work Group on Breastfeeding. (1997). Breastfeeding and the use of human milk. Pediatrics, 100(6), 1035–1039. https://doi.org/10.1542/peds.100.6.1035

Amini

Omani-Samani

Sepidarkish

Almasi-Hashiani

Hosseini

Maroufizadeh

(2019). The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF): A validation study in Iranian mothers. BMC Research Notes, 12(1), 1–6. https://doi.org/10.1186/s13104-019-4656-7

Asgarian

Hashemi

Pournikoo

Mirazimi

T.-S.

Zamanian

Amini-Tehrani

(2020). Translation, validation, and psychometric properties of Breastfeeding Self-Efficacy Scale-Short Form among Iranian women. Journal of Human Lactation, 36(2), 227–235. https://doi.org/10.1177/0890334419883572

Bandura

(1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191

Beck

C. T.

Bernal

Froman

R. D.

(2003). Methods to document semantic equivalence of a translated scale. Research in Nursing & Health, 26(1), 64–73. https://doi.org/10.1002/nur.10066

Bundesinstitut für Risikobewertung (BfR). (2007). Einheitliche Terminologie zur Säuglingsernährung. Aktualisierte Empfehlung (2007) der Nationalen Stillkommission von 1999 [Uniform terminology on infant feeding. Updated recommendation (2007) from the National Breastfeeding Commission in 1997]. https://www.mri.bund.de/fileadmin/MRI/Themen/Stillkommission/einheitliche_terminologie_zur_saeuglingsernaehrung.pdf

Bundesministerium für Ernährung und Landwirtschaft (BMEL). (2021). Stillen - Die beste Ernährung in den ersten Lebensmonaten [Breastfeeding—The best nutrition in the first months of life]. https://www.bmel.de/DE/themen/ernaehrung/gesunde-ernaehrung/schwangerschaft-und-baby/stillen.html

Bundesministerium Soziales, Gesundheit, Pflege und Konsumentenschutz (BMSGPK). (2014). Empfehlung der Nationalen Ernährungskommission. Österreichische Stillempfehlungen [Recommendation of the National Nutrition Commission. Austrian breastfeeding recommendations]. https://www.sozialministerium.at/Themen/Gesundheit/Eltern-und-Kind/Stillen-und-Beikost.html

10.

Bundesministerium Soziales, Gesundheit, Pflege und Konsumentenschutz (BMSGPK). (2021a). Stillen und Beikost [Breastfeeding and complementary food]. https://www.sozialministerium.at/Themen/Gesundheit/Eltern-und-Kind/Stillen-und-Beikost.html

11.

Bundesministerium Soziales, Gesundheit, Pflege und Konsumentenschutz (BMSGPK). (2021b). Sukie - Studie zum Stillverhalten und zur Kinderernährung in Österreich. Endbericht [Study on breastfeeding behavior and child nutrition in Austria. Final report]. https://sukie.ages.at

12.

Brandão

Mendonça

Dias

C. C.

Pinto

T. M.

Dennis

C.-L.

Figueiredo

(2018). The Breastfeeding Self-Efficacy Scale-Short Form: Psychometric characteristics in Portuguese pregnant women. Midwifery, 66, 49–55. https://doi.org/10.1016/j.midw.2018.07.014

13.

Brockway

Benzies

Hayden

K. A.

(2017). Interventions to improve breastfeeding self-efficacy and resultant breastfeeding rates: A systematic review and meta-analysis. Journal of Human Lactation, 33(3), 486–499. https://doi.org/10.1177/0890334417707957

14.

Chipojola

Chiu

H.-Y.

Huda

M. H.

Lin

Y.-M.

Kuo

S.-Y.

(2020). Effectiveness of theory-based educational interventions on breastfeeding self-efficacy and exclusive breastfeeding: A systematic review and meta-analysis. International Journal of Nursing Studies, 109, 103675. https://doi.org/10.1016/j.ijnurstu.2020.103675

15.

Christmann

van Aelst

(2006). Robust estimation of Cronbach’s alpha. Journal of Multivariate Analysis, 97(7), 1660–1674. https://doi.org/10.1016/j.jmva.2005.05.012

16.

Clark

L. A.

Watson

(1995). Constructing validity: Basic issues in objective scale development. Psychological Assessment, 7(3), 309–319. https://doi.org/10.1037/1040-3590.7.3.309

17.

Cohen

(1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates.

18.

Cohen

S. S.

Alexander

D. D.

Krebs

N. F.

Young

B. E.

Cabana

M. D.

Erdmann

Hays

N. P.

Bezold

C. P.

Levin-Sparenberg

Turini

Saavedra

J. M.

(2018). Factors associated with breastfeeding initiation and continuation: A meta-analysis. The Journal of Pediatrics, 203, 190–196. https://doi.org/10.1016/j.jpeds.2018.08.008

19.

Dai

Dennis

C.-L.

(2003). Translation and validation of the Breastfeeding Self-Efficacy Scale into Chinese. Journal of Midwifery & Women’s Health, 48(5), 350–356. https://doi.org/10.1016/S1526-9523(03)00283-6

20.

Dennis

C.-L.

(1999). Theoretical underpinnings of breastfeeding confidence: A self-efficacy framework. Journal of Human Lactation, 15(3), 195–201. https://doi.org/10.1177/089033449901500303

21.

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

22.

Dennis

C.-L.

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

23.

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

24.

Dennis

C.-L.

Heaman

Mossman

(2011). Psychometric testing of the Breastfeeding Self-Efficacy Scale-Short Form among adolescents. Journal of Adolescent Health, 49(3), 265–271. https://doi.org/10.1016/j.jadohealth.2010.12.015

25.

Dinno

(2009). Exploring the sensitivity of Horn’s parallel analysis to the distributional form of random data. Multivariate Behavioral Research, 44(3), 362–388. https://doi.org/10.1080/00273170902938969

26.

Dinno

(2018). paran: Horn’s test of Principal Components/Factors. R package version 1.5.2. https://CRAN.R-project.org/package=paran

27.

Dodt

R. C. M.

Ximenes

L. B.

Almeida

P. C.

Oriá

M. O. B.

Dennis

C.-L.

(2012). Psychometric and maternal sociodemographic assessment of the Breastfeeding Self-Efficacy Scale-Short Form in a Brazilian sample. Journal of Nursing Education and Practice, 2(3), 66–73. https://doi.org/10.5430/jnep.v2n3p66

28.

Ferketich

(1991). Focus on psychometrics. Aspects of item analysis. Research in Nursing & Health, 14(2), 165–168. https://doi.org/10.1002/nur.4770140211

29.

Galipeau

Baillot

Trottier

Lemire

(2018). Effectiveness of interventions on breastfeeding self-efficacy and perceived insufficient milk supply: A systematic review and meta-analysis. Maternal & Child Nutrition, 14(3), Article e12607. https://doi.org/10.1111/mcn.12607

30.

Gerhardsson

Nyqvist

K. H.

Mattsson

Volgsten

Hildingsson

Funkquist

E.-L.

(2014). The Swedish version of the Breastfeeding Self-Efficacy Scale-Short Form: Reliability and validity assessment. Journal of Human Lactation, 30(3), 340–345. https://doi.org/10.1177/0890334414523836

31.

Gregory

Penrose

Morrison

Dennis

C.-L.

MacArthur

. (2008). Psychometric properties of the Breastfeeding Self-Efficacy Scale-Short Form in an ethnically diverse U.K. sample. Public Health Nursing, 25(3), 278–284. https://doi.org/10.1111/j.1525-1446.2008.00705.x

32.

Horn

J. L.

(1965). A rationale and test for the number of factors in factor analysis. Psychometrika, 30(2), 179–185. https://doi.org/10.1007/BF02289447

33.

W.-Y.

Yeung

L.-S.

Choi

K.-C.

Chair

S.-Y.

Dennis

C.-L.

(2012). Translation and validation of the Hong Kong Chinese version of the Breastfeeding Self-Efficacy Scale-Short Form. Research in Nursing & Health, 35(5), 450–459. https://doi.org/10.1002/nur.21493

34.

Karall

Ndayisaba

J.-P.

Heichlinger

Kiechl-Kohlendorfer

Stojakovic

Leitner

Scholl-Bürgi

(2015). Breast-feeding duration: Early weaning—Do we sufficiently consider the risk factors? Journal of Pediatric Gastroenterology and Nutrition, 61(5), 577–582. https://doi.org/10.1097/MPG.0000000000000873

35.

Karall

Nindl

Zittera

Bier

von der Ohe

Guóth-Gumberger

Scholl-Bürgi

(2020). Stillen und Stillberatung [Breastfeeding and lactation counseling]. Monatsschrift Kinderheilkunde, 168(6), 547–560. https://doi.org/10.1007/s00112-020-00911-1

36.

Kassambara

(2023). rstatix: Pipe-friendly framework for basic statistical tests. R package version 0.7.2. https://cran.r-project.org/web/packages/rstatix/index.html

37.

Kersting

Hockamp

Burak

Lücke

(2020). Studie zur Erhebung von Daten zum Stillen und zur Säuglingsernährung in Deutschland-SuSe II [Study to collect data on breastfeeding and infant feeding in Germany-SuSe II]. In The German Nutrition Society (DGE) (Ed.), 14th DGE-Nutrition Report – Summary (1-28). https://www.dge.de/fileadmin/dok/english/nutrition-reports/14th/DGE-Nutrition-Report-summary-2020.pdf

38.

Kim

H.-Y.

(2013). Statistical notes for clinical researchers: Assessing normal distribution (2) using skewness and kurtosis. Restorative Dentistry & Endodontics, 38(1), 52–54. https://doi.org/10.5395/rde.2013.38.1.52

39.

Max Rubner Institut. (2019). Nationale Stillkommission [National Breastfeeding Commission]. https://www.mri.bund.de/de/themen/nationale-stillkommission/nationale-stillkommission/stillen/

40.

McCarter-Spaulding

D. E.

Dennis

C.-L.

(2010). Psychometric testing of the Breastfeeding Self-Efficacy Scale-Short Form in a sample of black women in the United States. Research in Nursing & Health, 33(2), 111–119. https://doi.org/10.1002/nur.20368

41.

McQueen

K. A.

Dennis

C.-L.

Stremler

Norman

C. D.

(2011). A pilot randomized controlled trial of a breastfeeding self-efficacy intervention with primiparous mothers. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 40(1), 35–46. https://doi.org/10.1111/j.1552-6909.2010.01210.x

42.

Menekse

Tiryaki

Ö.

Karakaya Suzan

Ö.

Cinar

(2021). An investigation of the relationship between mother’s personality traits, breastfeeding self-efficacy, and perception of insufficient milk supply. Health Care for Women International, 42(4–6), 925–941. https://doi.org/10.1080/07399332.2021.1892114

43.

Mundfrom

D. J.

Shaw

D. G.

T. L.

(2005). Minimum sample size recommendations for conducting factor analyses. International Journal of Testing, 5(2), 159–168. https://doi.org/10.1207/s15327574ijt0502_4

44.

Oliver-Roig

d’Anglade-González

M.-L.

García-García

Silva-Tubio

J.-R.

Richart-Martínez

Dennis

C.-L.

(2012). The Spanish version of the Breastfeeding Self-Efficacy Scale-Short Form: Reliability and validity assessment. International Journal of Nursing Studies, 49(2), 169–173. https://doi.org/10.1016/j.ijnurstu.2011.08.005

45.

Pajkossy

Simor

Szendi

Racsmány

(2015). Hungarian validation of the Penn State Worry Questionnaire (PSWQ): Method effects and comparison of paper-pencil versus online administration. European Journal of Psychological Assessment, 31(3), 159–165. https://doi.org/10.1027/1015-5759/a000221

46.

Pavicic Bosnjak

Rumboldt

Stanojevic

Dennis

C.-L

. (2012). Psychometric assessment of the Croatian version of the Breastfeeding Self-Efficacy Scale - Short Form. Journal of Human Lactation, 28(4), 565–569. https://doi.org/10.1177/0890334412456240

47.

Petrozzi

Gagliardi

(2016). Breastfeeding Self-Efficacy Scale: Validation of the Italian version and correlation with breastfeeding at 3 months. Journal of Pediatric Gastroenterology and Nutrition, 62(1), 137–139. https://doi.org/10.1097/MPG.0000000000000902

48.

R Core Team. (2022). R: A language and environment for statistical computing. (Version 4.2.2.) https://www.R-project.org/

49.

Radwan

Fakhry

Boateng

G. O.

Metheny

Bani Issa

Faris

M. E.

Obaid

R. S.

Al Marzooqi

Al Ghazal

Dennis

C.-L.

(2022). Translation and psychometric evaluation of the Arabic version of the Breastfeeding Self-Efficacy Scale-Short Form among women in the United Arab Emirates. Journal of Human Lactation, 39(1), 40–50. https://doi.org/10.1177/08903344221084623

50.

Rempel

L. A.

Rempel

J. K.

Moore

K. C. J.

(2017). Relationships between types of father breastfeeding support and breastfeeding outcomes. Maternal & Child Nutrition, 13(3), Article e12337. https://doi.org/10.1111/mcn.12337

51.

Revelle

(2019). Psych: Procedures for psychological, psychometric, and personality research. R package (Version 1.5.2). https://CRAN.R-project.org/package=psych

52.

Robert Koch Institut. (2020). AdiMon-Themenblatt: Stillen [AdiMon - Topic sheet: Breastfeeding]. https://www.rki.de/DE/Content/Gesundheitsmonitoring/Studien/Adipositas_Monitoring/Vor_und_nach_Geburt/PDF_Themenblatt_Stillen.pdf?__blob=publicationFile

53.

Ruch

Harzer

Proyer

R. T.

Park

Peterson

(2010). Ways to happiness in German-speaking countries: The adaptation of the German version of the Orientations to Happiness Questionnaire in paper-pencil and internet samples. European Journal of Psychological Assessment, 26(3), 227–234. https://doi.org/10.1027/1015-5759/a000030

54.

Sandhi

Lee

G. T.

Chipojola

Huda

M. H.

Kuo

S.-Y.

(2020). The relationship between perceived milk supply and exclusive breastfeeding during the first six months postpartum: A cross-sectional study. International Breastfeeding Journal, 15(1), 65. https://doi.org/10.1186/s13006-020-00310-y

55.

Tabachnick

B. G.

Fidell

L. S.

(2019). Using multivariate statistics (7th ed.). Pearson.

56.

Thulier

Mercer

(2009). Variables associated with breastfeeding duration. Journal of Obstetric, Gynecologic & Neonatal Nursing, 38(3), 259–268. https://doi.org/10.1111/j.1552-6909.2009.01021.x

57.

Tokat

M. A.

Okumuş

Dennis

C.-L.

(2010). Translation and psychometric assessment of the Breastfeeding Self-Efficacy Scale-Short Form among pregnant and postnatal women in Turkey. Midwifery, 26(1), 101–108. https://doi.org/10.1016/j.midw.2008.04.002

58.

United Nations Development Program. (2022). Human Development Report 2021/2022. https://hdr.undp.org/system/files/documents/global-report-document/hdr2021-22reportenglish_0.pdf

59.

Victora

C. G.

Bahl

Barros

A. J. D.

França

G. V. A.

Horton

Krasevec

Murch

Sankar

M. J.

Walker

Rollins

N. C.

(2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475–490. https://doi.org/10.1016/S0140-6736(15)01024-7

60.

Wheeler

B. J.

Dennis

C.-L.

(2013). Psychometric testing of the modified Breastfeeding Self-Efficacy Scale (Short Form) among mothers of ill or preterm infants. Journal of Obstetric, Gynecologic & Neonatal Nursing, 42(1), 70–80. https://doi.org/10.1111/j.1552-6909.2012.01431.x

61.

World Health Organization. (2020). Infant and young child feeding. https://www.who.int/en/news-room/fact-sheets/detail/infant-and-young-child-feeding

62.

Worthington

R. L.

Whittaker

T. A.

(2006). Scale development research. The Counseling Psychologist, 34(6), 806–838. https://doi.org/10.1177/0011000006288127

63.

Wutke

Dennis

C.-L.

(2007). The reliability and validity of the Polish version of the Breastfeeding Self-Efficacy Scale-Short Form: Translation and psychometric assessment. International Journal of Nursing Studies, 44(8), 1439–1446. https://doi.org/10.1016/j.ijnurstu.2006.08.001

64.

Zeiler

Peer

Philipp

Truttmann

Wagner

Karwautz

Waldherr

(2021). Web-based versus paper-pencil assessment of behavioral problems using the youth self-report. European Journal of Psychological Assessment, 37(2), 95–103. https://doi.org/10.1027/1015-5759/a000585

65.

Zhang

Yuan

K.-H.

(2016). Robust coefficients alpha and omega and confidence intervals with outlying observations and missing data: Methods and software. Educational and Psychological Measurement, 76(3), 387–411. https://doi.org/10.1177/0013164415594658

66.

Zhang

Yuan

K.-H.

(2023). coefficientalpha: Robust coefficient alpha and omega with missing and non-normal data. R package (Version 0.7.2). https://CRAN.R-project.org/package=coefficientalpha

67.

Zubaran

Foresti

Schumacher

Thorell

M. R.

Amoretti

Müller

Dennis

C. L.

(2010). The Portuguese version of the Breastfeeding Self-Efficacy Scale-Short Form. Journal of Human Lactation, 26(3), 297–303. https://doi.org/10.1177/0890334409359916