Department of Anthropology and Global Health, Northwestern University, Evanston, Illinois, USA.
Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.
Matern Child Nutr. 2018 Jul;14(3):e12579. doi: 10.1111/mcn.12579. Epub 2018 Jan 22.
The World Health Organization recommends exclusive breastfeeding (EBF) for 6 months and continued breastfeeding for at least 2 years. Social support has been widely recognized to influence breastfeeding practices. However, existing scales do not measure exclusive breastfeeding social support (EBFSS), rather they assess social support for any breastfeeding. Further, they are tailored towards high-income settings. Therefore, our objectives were to develop and validate a tool to measure EBFSS in low-income settings. To develop the scale, local and international breastfeeding experts were consulted on modifications to the Hughes' Breastfeeding Social Support Scale. It was then implemented in an observational cohort in Gulu, Uganda, at 1 (n = 238) and 3 (n = 237) months post-partum (NCT02925429). We performed polychoric and polyserial correlations to remove redundant items and exploratory factor analysis at 1 month post-partum to determine the latent factor structure of EBFSS. We further applied confirmatory factor analysis to assess dimensionality of the scale at 3 months post-partum. We then conducted tests of predictive, convergent, and discriminant validity against EBF, self-efficacy, general social support, and depression. The modification of the Hughes' scale resulted in 18 items, which were reduced to 16 after examining variances and factor loadings. Three dimensions of support emerged: Instrumental, Emotional, and Informational, with alpha coefficients of 0.79, 0.85, and 0.83, respectively. Predictive, convergent, and discriminant validity of the resultant EBFSS scale was supported. The EBFSS scale is valid and reliable for measuring EBFSS in northern Uganda and may be of use in other low-income settings to assess determinants of EBF.
世界卫生组织建议纯母乳喂养（EBF）持续 6 个月，并至少持续 2 年。社会支持已被广泛认为会影响母乳喂养行为。然而，现有的量表并不能衡量纯母乳喂养的社会支持（EBFSS），而是评估任何母乳喂养的社会支持。此外，这些量表是针对高收入环境定制的。因此，我们的目标是开发和验证一种在低收入环境中测量 EBFSS 的工具。为了开发该量表，我们咨询了当地和国际母乳喂养专家，对 Hughes 母乳喂养社会支持量表进行了修改。然后，该量表在乌干达古卢的一个观察性队列中进行了实施，分别在产后 1 个月（n=238）和 3 个月（n=237）时进行（NCT02925429）。我们进行了多元相关和多元序列相关，以消除冗余项目，并在产后 1 个月进行了探索性因素分析，以确定 EBFSS 的潜在因子结构。我们进一步应用验证性因素分析来评估产后 3 个月时量表的维度。然后，我们针对 EBF、自我效能、一般社会支持和抑郁进行了预测性、收敛性和判别有效性的测试。对 Hughes 量表的修改得到了 18 个项目，在检查方差和因子负荷后，将其减少到 16 个。支持出现了三个维度：工具、情感和信息，支持的 alpha 系数分别为 0.79、0.85 和 0.83。所产生的 EBFSS 量表的预测性、收敛性和判别有效性得到了支持。EBFSS 量表在乌干达北部是有效和可靠的，可用于其他低收入环境评估 EBF 的决定因素。
