Article: Clinical Research
The Breastfeeding Self‐Efficacy Scale: Psychometric Assessment of the Short Form

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Objective

The purpose of this study was to reduce the number of items on the original Breastfeeding Self‐Efficacy Scale (BSES) and psychometrically assess the revised BSES–Short Form (BSES‐SF).

Design

As part of a longitudinal study, participants completed mailed questionnaires at 1, 4, and 8 weeks postpartum.

Setting

Health region in British Columbia.

Participants

A population‐based sample of 491 breastfeeding mothers.

Main Outcome Measures

BSES, Edinburgh Postnatal Depression Scale, Rosenberg Self‐Esteem Scale, and Perceived Stress Scale.

Results

Internal consistency statistics with the original BSES suggested item redundancy. As such, 18 items were deleted, using explicit reduction criteria. Based on the encouraging reliability analysis of the new 14‐item BSES‐SF, construct validity was assessed using principal components factor analysis, comparison of contrasted groups, and correlations with measures of similar constructs. Support for predictive validity was demonstrated through significant mean differences between breastfeeding and bottle‐feeding mothers at 4 (p < .001) and 8 (p < .001) weeks postpartum. Demographic response patterns suggested the BSES‐SF is a unique tool to identify mothers at risk of prematurely discontinuing breastfeeding.

Conclusions

These psychometric results indicate the BSES‐SF is an excellent measure of breastfeeding self‐efficacy and considered ready for clinical use to (a) identify breastfeeding mothers at high risk, (b) assess breastfeeding behaviors and cognitions to individualize confidence‐building strategies, and (c) evaluate the effectiveness of various interventions and guide program development.

Section snippets

Theoretical Framework

Recently, self-efficacy has received considerable attention as a predictor of health-related behaviors. Defined as an individual’s confidence in his or her perceived ability to perform a specific task or behavior (Bandura, 1977), self-efficacy is composed of two parts: (a) outcome expectancy, the belief that a given behavior will produce a particular outcome, and (b) self-efficacy expectancy, an individual’s conviction that one can successfully perform certain tasks or behaviors to produce the

Sample

Participants completed questionnaires as part of a longitudinal study conducted near Vancouver, British Columbia, between April and January 2002. Women eligible to participate in the psychometric assessment of the BSES were all breastfeeding mothers who were at least 18 years of age, able to understand English, and had a singleton birth at 37 weeks gestation or greater. Mothers were excluded if they had a factor that could significantly interfere with breastfeeding, such as an infant in the

Sample

One hundred sixty-four participants were recruited antenatally, and 104 (63%) returned the 1-week postpartum questionnaire. Of the approximately 971 women screened postnatally, 857 were eligible; the most common reason for ineligibility was inability to read English (n = 27, or 24% of those ineligible). Of the eligible women, 190 (22%) declined enrollment, most frequently citing stress (n = 61, 32%) or lack of interest (n = 59, 31%). Of the 667 postnatal mothers who agreed to participate in the

Discussion

Theoretically based on Bandura’s social cognitive theory, the BSES-SF is an instrument that measures a mother’s confidence in her ability to breastfeed her new baby. This psychometric assessment not only provides additional support for the reliability of the BSES-SF but also evaluates maternal breastfeeding self-efficacy across the postpartum period. Consistent with the original methodological study (Dennis & Faux, 1999), reliability of the 33-item BSES was demonstrated through good estimates

Acknowledgments

The author gratefully acknowledges the Canadian Institutes for Health Research (CIHR) for the provision of a postdoctoral research fellowship (1999-2001) and the Fraser Valley research team, including Margaret Gander, Patricia Whitehead, Linda Bachmann, Alana Boucher, Terry Gust, Pam Munro, Tina Regehr, Heidi Beckerleg, Yvette Szabo, Mona Taylor, and Linda Winner.

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