A systematic review of measures assessing mothers' knowledge, attitudes, confidence and satisfaction towards breastfeeding.

In order to support breastfeeding interventions, there is a need for objective, reliable, valid and sensitive measures of factors related to breastfeeding. Publications on the development and testing of tools measuring mothers' knowledge, attitudes, confidence or self-efficiency and/or satisfaction towards breastfeeding were systematically reviewed. Twenty-two papers evaluating 13 self-report measures matched our selection criteria, and were critically appraised by two independent reviewers. All scales were tested with pregnant women or breastfeeding mothers. The 13 measures varied markedly in ease of completion and cultural appropriateness and none reached our highest level of evidence grading. Four of the measures had sufficient evidence to support their use, including the Breastfeeding Attrition Prediction Tool, the Modified Breastfeeding Evaluation Scale, the Breastfeeding Self-Efficiency Scale and the Iowa Infant Feeding Attitude Scale. There has been a tendency to develop new measures rather than evaluate the strengths and weaknesses of existing measures, particularly in different populations.