Journal List > Korean J Women Health Nurs > v.22(4) > 1089547

Yang, Jeong, and Seo: Development of a Breastfeeding Effectiveness Scale (BES)

Abstract

Purpose

The purpose of this study was to develop and evaluate breastfeeding effectiveness scale to measure effectiveness of breastfeeding for mothers in the early postpartum period.

Methods

A conceptual framework was constructed from properties of effective breastfeeding (Yang and Seo, 2011), and item construction was derived from literature review and analysis of the data along with interviews with breastfeeding mothers. Content validity was tested by experts. Each item was scored on a five-point Likert scale. The preliminary questionnaire was administered to 248 breastfeeding mothers. Data were analyzed using item analysis, factor analysis, Pearson correlation coefficients, and Cronbach's ⍺.

Results

From the factor analysis, 20 items in seven factors were derived. The factors were identified as mother's satisfaction, suckling, assurance of milk quantity, infant's satisfaction, latching on, infant's feeding desire, and breastfeeding positioning. The seven factors explained 65.1% of total variance, Cronbach's ⍺ of the total items was .83 and the factors ranged from .44 to .75.

Conclusion

Results of this study suggest that breastfeeding effectiveness scale is a reliable and valid instrument to measure breastfeeding effectiveness of mothers in the early postpartum period.

REFERENCES

1. Cooke M, Sheehan A, Schmied V. A Description of the relationship between breastfeeding experiences, breastfeeding satisfaction, and weaning in the first 3 months after birth. Journal of Human Lactation. 2003; 19(2):145–146.
crossref
2. Kronborg H, Vaeth M. How are effective breastfeeding technique and pacifier use related to breastfeeding problems and breastfeeding duration? Birth. 2009; 36(1):34–42.
crossref
3. Shrago L, Bocar D. The infant's contribution to breastfeeding. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 1990; 19(3):209–215.
crossref
4. Mulford C. The Mother-Baby Assessment(MBA): An “Apgar score" for breastfeeding. Journal of Human Lactation. 1992; 8(2):79–82.
5. Jensen D, Wallace S, Kelsay P. LATCH: A breastfeeding charting system and documentation tool. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 1994; 23(1):27–32.
crossref
6. Mulder PJ, Johnson TS. The beginning breastfeeding survey: Measuring mother's perceptions of breastfeeding effectiveness during the postpartum hospitalization. Research in Nursing & Health. 2010; 33(4):329–344.
crossref
7. Mulder PJ. A concept analysis of effective breastfeeding. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2006; 35(3):332–339.
crossref
8. Yang HJ, Seo JM. Concept analysis of effective breastfeeding. Korean Journal of Women Health Nursing. 2011; 17(4):317–327.
crossref
9. Jeong GH. Effect of the nursing intervention program on promoting the breastfeeding practice in primipara [dissertation]. Seoul: Ewha Womans University;1997. p. 1–133.
10. Lee EJ. The effect of prenatal breastfeeding education on breastfeeding practice and retention of knowledge [master's thesis]. Daegu: Keimyung University;1997. p. 1–60.
11. Kim SH. Development of a breast feeding adaptation scale. Journal of Korean Academy of Nursing. 2009; 39(2):259–269.
12. Kim YM, Park YS. A study on the development of the Korean breastfeeding empowerment scale. Korean Journal of Women Health Nursing. 2004; 10(4):360–367.
crossref
13. Dennis CL. The breastfeeding self-efficacy scale: Psychometric assessment of the short form. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2003; 32(6):734–744.
crossref
14. Matthews MK. Developing an instrument to assess infant breastfeeding behaviour in the early neonatal period. Midwifery. 1998; 4(4):154–165.
crossref
15. Johnson TS, Mulder PJ, Strube K. Mother-infant breastfeeding progress tool: a guide for education and support of the breastfeeding dyad. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2007; 36(4):319–327.
crossref
16. Leff EW, Jefferis SC, Gagne MP. The development of the maternal breastfeeding evaluation scale. Journal of Human Lactation. 1994; 10(2):105–111.
crossref
17. Lee EO, Im NY, Park HA, Lee IS, Kim JI, Bae JY, et al. Nursing research and statistical analysis. 1st ed.Seoul: Soomoonsa;2009. p. 1–733.
18. Stevens J. Applied multivariate statistics for the social sciences. Mahwah, NJ: Lawrence Erlbaum Associates;1996. p. 1–659.
19. Yang HJ, Seo JM. A structural model for primiparas' breastfeeding behavior. Journal of Korean Academy of Nursing. 2013; 43(3):399–408.
crossref
20. Lee HS, Im JH. Structural equation modeling with AMOS 18.0/19.0. 1st ed.Seoul: Jiphyeonjae;2011. p. 1–319.
21. Pett MA, Lackey NR, Sullivan JJ. Making sense of factor analysis: The use of factor analysis for instrument development in health care research. California: Sage publication;2003. p. 1–348.
22. Kim SK, Kim YK, Kim HR, Park CS, Shon SK, Choi YJ, et al. The 2012 national survey on fertility, family health and welfare in Korea. Research report. Seoul: Korea Institute for Health and Social Affairs;2012. Report No.:. p. 2012–54.
23. Netsu Y. Breast management. 2nd ed.Kim YR. translator. Seoul: Knowledge and creative;2007. 25.
24. Streiner DL. Starting at the beginning: An introduction to coefficient alpha and internal consistency. Journal of Personality Assessment. 2003; 80(1):99–103.
crossref

Figure 1.
Conceptual framework of breastfeeding effectiveness.
kjwhn-22-264f1.tif
Figure 2.
Result of confirmatory factor analysis.
kjwhn-22-264f2.tif
Table 1.
General Characteristics of Participants (N=248)
Characteristics Categories n (%) or M±SD
Maternal age (yr)   31.1±3.7
≤24 6 (2.4)
25~29 84 (33.9)
30~34 116 (46.8)
35~40 40 (16.1)
≥40 2 (0.8)
Education High school 45 (18.1)
≥College 203 (81.9)
Occupation Yes 102 (41.1)
No 146 (58.9)
Health status Very healthy 23 (9.3)
Healthy 100 (40.3)
Not bad 114 (46.0)
Poor health 11 (4.4)
Parity Primiparous 175 (70.6)
Multiparous 73 (29.4)
Antenatal breastfeeding education Yes 78 (31.5)
No 170 (68.5)
Mode of delivery Vaginal 116 (46.8)
Cesarean section 132 (53.2)
Gestation weeks   38.9±1.1
Age of neonates (range: 1~20 days)   6.5±3.9
Place of postpartum care Postpartum care centers 119 (48.0)
Home 72 (29.0)
My parent's home 52 (21.0)
My husband's home 5 (2.0)
Rooming-in implementation Yes 60 (50.4)
No 59 (49.6)
Rooming-in times (hours)   4.5±3.6
Number of feeding per day   4.7±1.7
Providing supplementary feeding Yes 201 (81.0)
No 47 (19.0)
Reasons for supplemental feeding Needs of the mother or guardian 112 (55.7)
Daily performance of the neonatal 81 (40.3)
Medical reasons 8 (4.0)
Table 2.
Factor Analysis and Reliability (N=248)
No Item Factor loading C Cronbach's ⍺
Factor 1 Factor 2 Factor 3 Factor 4 Factor 5 Factor 6 C Factor 7
30 I feel confident about breastfeeding my baby .87 .15 .19 .10 .13 .02 .02 .75
29 Breastfeeding my baby is easy .83 .20 .16 .05 .18 .11 .08  
28 I feel pleasant and happy about breastfeeding .59 .14 -.09 .27 -.02 -.22 .28  
3 After breastfeeding, I felt inconvenience in the shoulders, neck, and wrist, etc .55 -.03 -.27 -.07 .10 .55 -.05  
6 During breastfeeding, the nipple did not slide from the baby's mouth .11 .75 .21 .07 .06 .05 .00 .72
7 My baby eagerly opened mouth wide and bite areola enough .13 .70 .06 .09 .32 .13 .13  
12 My baby sucks strongly with a regular rhythm .23 .65 .08 .17 -.01 .23 .04  
15 When sucking mother's milk, another breast oozes with milk .02 .19 .79 .07 -.04 -.21 .18 .73
23 Milk quantity is enough for my baby .23 .18 .76 .22 -.08 .16 -.01  
24 My baby sucks 8~12 times a day -.03 .02 .71 .14 .36 .24 -.06  
22 I fed until my baby stopped sucking by oneself being full .13 .03 .04 .83 -.11 .03 .06 .62
21 I fed whenever my baby wants to eat .00 .17 .20 .66 .16 .07 -.03  
27 After breastfeeding, my baby fell asleep with satisfactory look .21 .24 .35 .53 .06 .23 .09  
4 To protrude nipple, placed a thumb on the upper part of nipple, and the rest fingers supporting under the breast .12 -.04 -.01 -.02 .75 .11 .15 .44
8 The lips biting the breast turned reversed outwardly .13 .30 .10 -.04 .55 .06 -.15  
9 The nipple was on the baby's tongue .06 .41 .04 .24 .53 -.22 .15  
20 My baby was not interested in breastfeeding -.03 .42 .09 .20 .01 .59 .10 .58
17 When taking my baby‘s mouth nearby the breast, my baby opens the mouth and tries to bite the nipple -.05 .36 .28 .11 .08 .57 .14  
1 I fed face to face with my baby .08 .19 .15 -.07 -.02 -.02 .83 .44
2 I fed in the posture of straight shoulders and waist .16 -.09 -.06 .25 .25 .32 .62  
Total item               .83
Eigen value 2.36 2.33 2.20 1.78 1.55 1.47 1.34  
Explained variance (%) 11.80 11.63 10.99 8.88 7.77 7.34 6.70  
Cumulative variance (%) 11.80 23.42 34.41 43.29 51.07 58.40 65.10  

Factor 1=Mother's satisfaction; Factor 2=Suckling; Factor 3=Assurance of milk quantity; Factor 4=Infant's satisfaction; Factor 5=Latch on; Factor 6=Infant's feeding desire; Factor 7=Breastfeeding position.

Table 3.
Relationships between 7 Factors of Breastfeeding Effectiveness Scale and Beginning Breastfeeding Survey (N=248)
Scale Factor BES BES total score
Factor 1 Factor 2 Factor 3 Factor 4 Factor 5 Factor 6 Factor 7
r (p) r (p) r (p) r (p) r (p) r (p) r (p)
BES Factor 1 1.00              
Factor 2 .36 (<.001) 1.00            
Factor 3 .17 (.007) .37 (<.001) 1.00          
Factor 4 .30 (<.001) .39 (<.001) .42 (<.001) 1.00        
Factor 5 .32 (<.001) .39 (<.001) .21 (.001) .19 (.003) 1.00      
Factor 6 .22 (.001) .48 (<.001) .34 (<.001) .37 (<.001) .25 (<.001) 1.00    
Factor 7 .29 (<.001) .25 (<.001) .17 (.008) .24 (<.001) .23 (<.001) .25 (<.001) 1.00  
BBS MBCES .79 (<.001) .48 (<.001) .33 (<.001) .46 (<.001) .35 (<.001) .37 (<.001) .37 (<.001)  
MDA .59 (<.001) .28 (<.001) .07 .17 (<.001) .29 (<.001) .11 .26 (<.001)  
IBSES .42 (<.001) .61 (<.001) .39 (<.001) .58 (<.001) .42 (<.001) .54 (<.001) .32 (<.001)  
BBS total score               .80 (<.001)

BES=breastfeeding effectiveness scale; Factor 1=mother's satisfaction; Factor 2=suckling; Factor 3=assurance of milk quantity; Factor 4=infant's satisfaction; Factor 5=latch on; Factor 6=infant's feeding desire; Factor 7=breastfeeding position; BBS=beginning breastfeeding survey; MBCES=maternal breastfeeding competence and emotional satisfaction; MDA=maternal discomfort and anxiety; IBSES=infant breastfeeding skill and emotional satisfaction.

TOOLS
Similar articles