CLINICAL STUDIESReliability and Validity Testing of Three Breastfeeding Assessment Tools
Section snippets
Background
Neonatal suckling behavior is a measure of behavioral organization. Effective suckling behavior suggests that an infant has achieved the maturity required for effective oral feedings and subsequent survival (Medoff-Cooper & Ray, 1995). Rooting and suckling are influenced by infant age and state of wakefulness (Anderson et al., 1982, Gentry and Aldrich, 1948, Pollitt et al., 1981, Weber et al., 1986). The neonate’s ability to suckle and to root progressively matures after birth (Bowen-Jones et
Sample
Twenty-eight feedings at the breast were videotaped using a convenience sample of 13 breastfeeding mothers and their neonates in a Midwestern city hospital. The study was explained, and informed consent was obtained. The mothers were white and ranged from ages 20 to 36 years. All infants were healthy, full-term, and had Apgar scores at 5 minutes of 9 or above. Participants were experienced and inexperienced mothers with different breastfeeding experiences. Eight had breastfed previously.
Instruments
The
Results
Five of the 28 observations were of insufficient quality for inclusion in the study. Thus, 23 observations were rated by three raters using three instruments. Estimates of interrater reliability were obtained using Spearman correlation coefficients calculated for all pairwise ratings. These estimates ranged from .27 to .69 for the IBFAT, .11 to .46 for the LATCH assessment tool, and .33 to .66 for the MBA (See Table 2). Pairwise, Spearman correlation coefficients to related scores among the
Discussion and Implications
Perhaps the most striking finding was a lack of consistency in the way the raters rank-ordered the ratings. It was expected that because they were measuring the exact same feeding at the breast on videotape, score correlations would be higher. These results indicate that the IBFAT, LATCH assessment tool, and MBA are not sufficiently reliable in their current form for clinical practice. Although there is no magical cutoff point that prevents a tool from being considered reliable, a correlation
Acknowledgment
This research was supported by a grant from Wichita State University, School of Nursing, Wichita, KS.
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