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

Development and Validation of Co-Authors a Self-efficacy Theory-based Instrument to Measure • Linda L. Knol, PhD, RD • Kristine R. Graettinger, MD Prenatal Breastfeeding • Dept. of Human Nutrition and • College of Community Health Hospitality Management at Sciences and The University Self-efficacy and The University of Alabama of Alabama Medical Center Breastfeeding Intention among • Lori W. Turner, PhD, RD • Maria Hernandez-Reif, PhD Pregnant Women • Dept. of Health Science at • Dept. of Human Development and The University of Alabama Family Studies at The University of Alabama • Joy J. Burnham, PhD • James D. Leeper, PhD ERIN MCKINLEY, PHD, RD, LDN, CLC, CHES • Dept. of Educational Studies in • Dept. of Community Medicine and Psychology, Research LOUISIANA STATE UNIVERSITY AND THE LSU AG CENTER Population Health and Methodology & Counseling at The University of Alabama The University of Alabama Presenter Disclosures Study Rationale Erin M. McKinley The choice to engage in breastfeeding may be related to the level of The following personal financial relationships with self-efficacy a woman has to complete the task commercial interests relevant to this presentation existed during the past 12 months: Current available breastfeeding self-efficacy (BF SE) scales are not fully No relationships to disclose 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. 1

Survey Methods • Breastfeeding Intention (3) • Expert Panel • Breastfeeding intention was measured with 3 questions adapted from guidelines • Face and content validity on formatting a scale to measure general intention to engage in a behavior • Five experts total from the following areas: • 7-point Likert-type scale with 1 being strongly disagree and 7 being strongly agree with a possible range of 3 – 21 ◦ Health Behavior Theory • A higher average score reflects a higher intent to initiate breastfeeding after the ◦ Breastfeeding birth of the child ◦ Instrument Development • SE Theory Items (39) Demographic Items (22) • Pilot Study ◦ Performance Accomplishment • Readability, comprehensibility, and time ◦ Vicarious Experience • ◦ Verbal Persuasion 5 pregnant women ◦ Physiological Cues • Convenience sample ◦ Cognitive Processes ◦ University of Alabama UMC OB/GYN patients ◦ Affective Processes Full Study Sample Results • • Convenience sampling from patient population of the OB/GYN clinic at Confirmatory factor analysis determined the model did not fit • The University of Alabama University Medical Center Chi-square totaled 2445.09 with 687 degrees of freedom (p <.001) • Goodness of fit index (GFI) =.480; desirable GFI ≥.90 • Inclusion Criteria • Root mean square error of approximation (RMSEA) =.144; desirable RMSEA ≤.05 • Pregnant with one child • Normed fit index (NFI) =.641; desirable NFI ≥.90 • Between 18 and 50 years of age • Exploratory factor analysis • 124 participants in the final analysis • Four factors extracted with an eigenvalue of 1.00 or greater • • 26.2 years ± 4.68 years with a range of 18 to 38 years. The four factors explained a total of 74.05% of the variance. • Item loadings were all above .412 • Incentive • All 39 questions were retained in the model • $5 cash for all survey participants • Internal consistency measured using Cronbach’s alpha; α = .980 • Retest returns entered to win one of ten $25 Walmart gift cards • The four factors: I) Individual Processes, II) Interpersonal Processes, III) Professional Advice, and IV) Social Support Model of Prenatal BF SE 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. 2

Conclusions Implications • • Creation of the Prenatal Rating of Efficacy in Preparation to Breastfeed This study found a new, valid, and reliable instrument for measuring BF Scale (PREP to BF) SE in the prenatal period. Valid (α=.980) and reliable (r=.920) measure of breastfeeding self -efficacy ◦ • The instrument may used be to measure a prenatal woman’s SE and among pregnant women in the prenatal period reveal areas the mother may need to address before she gives birth, such as goal setting skills or overcoming barriers. • BF SE during pregnancy is correlated to BF intention. • Educational programs aimed at increasing pregnant mothers’ ◦ Those women with higher breastfeeding self-efficacy also had higher confidence are needed. breastfeeding intention, and vice-versa (r=.610, p<.001) ◦ Focus on: goal setting, overcoming barriers, increasing comfort with BF, and developing communication skills to properly discuss BF with health professionals, family, and friends • Prenatal BF SE scores significantly differ by certain sociodemographic factors. • 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. 3