Breastfeeding Measurement - Choosing a Scale to Measure Breastfeeding Attitudes and Beliefs

Abstract

The World Health Organization recommends exclusive breastfeeding for the first six months of life and continued breastfeeding for up to two years. A mother’s ability to initiate and sustain breastfeeding is shaped by complex individual- and community-level attitudes, beliefs, and knowledge, making it challenging to measure these factors across diverse contexts. This paper presents a comprehensive overview of existing instruments that assess breastfeeding attitudes, beliefs, and knowledge to facilitate the selection of appropriate tools, building upon existing reviews that have examined validated instruments for attitudes, knowledge, self-efficacy, and social support. This review aims to support researchers, program designers, and policymakers in choosing tools that align with their specific objectives, populations, and theoretical frameworks. A curated selection of validated instruments is presented in table format, highlighting constructs such as self-efficacy, attitudes, and beliefs. These tools were selected based on their relevance to general maternal populations, use in peer-reviewed research, and applicability across the breastfeeding continuum. Key domains included in the table are the construct measured, item format and scoring, considerations for tool selection, and examples of translation and cultural adaptation. Included instruments are psychometrically robust with established validity and reliability, and many have been adapted for and tested in diverse cultural settings. The table reveals that while many instruments demonstrate strong reliability and validity, their scope, cultural adaptability, and focus across the breastfeeding timeline vary considerably.