The World Health Organization (WHO) recommends that women breastfeed their children for 2 years and that children have only breast milk for their first 6 months of life (WHO, 2003). Health care professionals are challenged to promote breastfeeding because, “Breast milk is widely acknowledged to be the most complete form of nutrition for infants, with a range of benefits for infants’ health, growth, and development” (WHO, 2003, p. 3). Moreover, breastfeeding improves maternal health long after the postpartum period (CDC). Health promotion requires high health behavior confidence (Hausman, 2003 and Rodriguez-Palmero, Koletzko, Kunz, Jensen, 1999).
Most women have a plan about breastfeeding before they conceive (Baumslag & Michels, 1995; Leeson, Kattenhorn, Deanfield, Lucas 2001; and Stuebe, Michels, Willett, Manson, Rexrode, & Rich-Edwards, 2009). A woman whose preconception plan is not to breastfeed and who changes her mind prenatally is likely to quit breastfeeding earlier and more easily than a woman whose preconception plan is to breastfeed (Torgus & Gotsch, 2004 and Spatz, 2006). The development of research instruments with satisfactory psychometric properties to measure breastfeeding confidence is necessary before randomized clinical trials of interventions to increase confidence can be conducted and effectively evaluated. To date, no studies have used a randomized clinical trial design to evaluate the effect of interventions on the breastfeeding confidence of women.
The instrument known as Breastfeeding Personal Efficacy Beliefs Inventory measures breastfeeding confidence to predict breastfeeding initiation and duration the first year after giving birth (Bartick & Reinhold, 2010). On the other hand, the Breastfeeding Self-Efficacy Scale (Torres, Torres, Rodriguez, & Dennis, 2003) measures breastfeeding confidence after breastfeeding is initiated to predict women’s breastfeeding perseverance up to 6 weeks after giving birth. Because the purposes of the instruments are different, their confidence assessments are different. For example, women’s confidences about their capability to breastfeed for 3 months, 6 months, and 1 year, and their capability to breastfeed in diverse environments are assessed in the instrument reported here. The Torres, et al. (2003) instrument assesses more deeply women’s confidence about their capability to manage breastfeeding’s initial techniques and challenges. Understanding women’s confidence about accomplishing all aspects of breastfeeding in all circumstances will assist health care professionals in meeting the challenge of promoting breastfeeding.
Although breastfeeding was initiated by 69% of mothers in the United States, after 6 months, only 29% of babies were receiving breast milk (Picciano, 2001). The United States government and multiple health professional organizations recommend breastfeeding for 1 year. In the paper of Kramer & Kakuma (2002), they calls for 75% of women to breastfeed after birth and for 50% of women to be breastfeeding at 6 months after birth. These goals do not specify amounts of the child’s diet that should be breast milk. However, in 1990, standard research definitions for amount of diet provided by breast milk were established (Agostoni & Haschke 2003 and Der, Batty, Deary, 2006). A full breast milk diet is exclusively, or almost 100%, breast milk. Partial breast milk diets consist of high, which is above 80%, medium, which is 79% to 20%, and low, which is below 20%. Token breastfeeding makes an insignificant caloric contribution to the child’s diet (Pryor, 1997).
Older and more educated women and those that live in the Western United States have been more likely to breastfeed (Pryor, 1997 and Vennemann, Bajanowski, Brinkmann, Jorch, Yücesan, Sauerland, Mitchell (2009). Currently, many women are discouraged from breastfeeding because of diminished confidence. Successful practice before pregnancy and birth is hindered by breastfeeding’s physiology. It is difficult to practice a behavior that requires hormonal readiness and a child. Successful role modeling of breastfeeding is hindered because of the low occurrence of breastfeeding in the United States. Successful verbal persuasion about breastfeeding is negatively impacted by the discomfort that many people feel at the sight of a child breastfeeding. Many breastfeeding women experience rudeness from others both in public and at home (Huggins, 1999). Often, women who are from the older generation do not encourage women who are younger to breastfeed. This is important because, in traditional areas of the country, older women influence the health behavior of their extended families (Kunz, Rodriguez-Palmero, Koletzko& Jensen, 1999). Finally, achieving a comfortable physiological state with breastfeeding is hindered by the lack of breastfeeding knowledge. Information about how to put the child to breast, how to get assistance with the child, and methods of increasing and decreasing milk supply have been lost to the general public because of years of low breastfeeding rates.
Instruments that measure personal efficacy beliefs have been developed by multiple researchers to promote other health behaviors, to increase self-management of disease, to improve academic achievement, and to counsel about career choice (Horwood, Darlow, Mogridge, 2001 and Armstrong & Reilly 2002). To date, there is no instrument that measures women’s breastfeeding personal efficacy beliefs other than after breastfeeding is initiated.
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