Co-Authors a Self-efficacy Theory-based Instrument to Measure - - PDF document

1 Development and Validation of a Self-efficacy Theory-based Instrument to Measure Prenatal Breastfeeding Self-efficacy and Breastfeeding Intention among Pregnant Women

ERIN MCKINLEY, PHD, RD, LDN, CLC, CHES LOUISIANA STATE UNIVERSITY AND THE LSU AG CENTER

Co-Authors

• Linda L. Knol, PhD, RD
• Dept. of Human Nutrition and

Hospitality Management at The University of Alabama

• Lori W. Turner, PhD, RD
• Dept. of Health Science at

The University of Alabama

• Joy J. Burnham, PhD
• Dept. of Educational Studies in

Psychology, Research Methodology & Counseling at The University of Alabama

• Kristine R. Graettinger, MD
• College of Community Health

Sciences and The University

• f Alabama Medical Center
• Maria Hernandez-Reif, PhD
• Dept. of Human Development and

Family Studies at The University

• f Alabama
• James D. Leeper, PhD
• Dept. of Community Medicine and

Population Health and The University of Alabama

Presenter Disclosures

The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Erin M. McKinley No relationships to disclose

Study Rationale

The choice to engage in breastfeeding may be related to the level of self-efficacy a woman has to complete the task Current available breastfeeding self-efficacy (BF SE) scales are not fully self-efficacy theory-based and are not validated to appropriately measure prenatal BF SE among pregnant women Create the first theory-driven study to develop and validate a self-efficacy theory-based instrument that measures prenatal BF SE and BF intention among a pregnant population for use in clinical and research settings

Self-efficacy Theory Objectives

• Create, test, and validate a new scale to measure prenatal

breastfeeding self-efficacy

• Test the reliability of the scale
• Determine the correlation between prenatal breastfeeding

self-efficacy and breastfeeding intention

• Assess the differences in prenatal breastfeeding

self-efficacy by the sociodemographic factors.

2

Survey

• Breastfeeding Intention (3)
• Breastfeeding intention was measured with 3 questions adapted from guidelines
• n formatting a scale to measure general intention to engage in a behavior
• 7-point Likert-type scale with 1 being strongly disagree and 7 being strongly

agree with a possible range of 3 – 21

• A higher average score reflects a higher intent to initiate breastfeeding after the

birth of the child

• SE Theory Items (39)

Demographic Items (22)

• Performance Accomplishment
• Vicarious Experience
• Verbal Persuasion
• Physiological Cues
• Cognitive Processes
• Affective Processes

Methods

• Expert Panel
• Face and content validity
• Five experts total from the following areas:
• Health Behavior Theory
• Breastfeeding
• Instrument Development
• Pilot Study
• Readability, comprehensibility, and time
• 5 pregnant women
• Convenience sample
• University of Alabama UMC OB/GYN patients

Full Study Sample

• Convenience sampling from patient population of the OB/GYN clinic at

The University of Alabama University Medical Center

• Inclusion Criteria
• Pregnant with one child
• Between 18 and 50 years of age
• 124 participants in the final analysis
• 26.2 years ± 4.68 years with a range of 18 to 38 years.
• Incentive
• $5 cash for all survey participants
• Retest returns entered to win one of ten $25 Walmart gift cards

Results

• Confirmatory factor analysis determined the model did not fit
• Chi-square totaled 2445.09 with 687 degrees of freedom (p <.001)
• Goodness of fit index (GFI) =.480; desirable GFI ≥.90
• Root mean square error of approximation (RMSEA) =.144; desirable RMSEA ≤.05
• Normed fit index (NFI) =.641; desirable NFI ≥.90
• Exploratory factor analysis
• Four factors extracted with an eigenvalue of 1.00 or greater
• The four factors explained a total of 74.05% of the variance.
• Item loadings were all above .412
• All 39 questions were retained in the model
• Internal consistency measured using Cronbach’s alpha; α = .980
• The four factors: I) Individual Processes, II) Interpersonal Processes,

III) Professional Advice, and IV) Social Support

Results

• Each factor’s test and retest means were highly and significantly

correlated.

• BF intention and total prenatal BF SE score were highly and

significantly correlated (.610, P <.001).

• Women who had at least some college education (P =.003), were

currently married (P =.027), had breastfed previously (P =.035), and planned to deliver vaginally (P =.043) had significantly greater total scores than their counterparts.

• No significant differences in mean total scores were seen between

groups by race, age, parity, having been breastfed as a child, pre- pregnancy BMI, and plan to return to work.

Model of Prenatal BF SE

3

Conclusions

• Creation of the Prenatal Rating of Efficacy in Preparation to Breastfeed

Scale (PREP to BF)

• Valid (α=.980) and reliable (r=.920) measure of breastfeeding self-efficacy

among pregnant women in the prenatal period

• BF SE during pregnancy is correlated to BF intention.
• Those women with higher breastfeeding self-efficacy also had higher

breastfeeding intention, and vice-versa (r=.610, p<.001)

• Prenatal BF SE scores significantly differ by certain sociodemographic

factors.

Implications

• This study found a new, valid, and reliable instrument for measuring BF

SE in the prenatal period.

• The instrument may used be to measure a prenatal woman’s SE and

reveal areas the mother may need to address before she gives birth, such as goal setting skills or overcoming barriers.

• Educational programs aimed at increasing pregnant mothers’

confidence are needed.

• Focus on: goal setting, overcoming barriers, increasing comfort with BF,

and developing communication skills to properly discuss BF with health professionals, family, and friends

• Measuring the level of prenatal BF SE could alert prenatal women and

health professionals to specific, individual skill sets needed to successfully initiate BF after birth.

QUESTIONS?

This study is now published online! https://journals.sagepub.com/doi/pdf/10.1177/0890334418799047 McKinley, E. M., Knol, L. L., Turner, L. W., Burnham, J. J., Graettinger, K. R., Hernandez-Reif, M., & Leeper, J. D. (2018). The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale: A New Measurement Instrument for Prenatal Breastfeeding Self-efficacy. Journal of Human Lactation, published online September 25, 2018.

Thank you for attending.