The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF): German Translation and Psychometric Assessment.

BACKGROUND: German-speaking mothers have breastfeeding rates below the international breastfeeding recommendations. Previous research has found that breastfeeding self-efficacy is an important and modifiable predictor of breastfeeding outcomes, thus improving breastfeeding rates. The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) is used in many countries to assess maternal breastfeeding self-efficacy. This instrument has not been available in German. RESEARCH AIMS: To translate the BSES-SF into German and assess its psychometric properties among breastfeeding mothers up to 12 weeks postpartum. METHODS: This cross-sectional study was conducted online with 355 breastfeeding mothers recruited from breastfeeding groups through Facebook. The BSES-SF was translated into German using forward and back-translation. To test reliability, item-total characteristics, including Cronbach's alpha, were examined. We used principal component analysis, as well as known-groups comparisons for evaluating construct validity, and examined the relationship between breastfeeding self-efficacy and demographic variables. RESULTS: The mean age of participants was 32.4 years (SD = 4.32). The Cronbach's alpha coefficient was .88 and corrected item-total correlations ranged between .37 and .73. Principal components analysis yielded one component with factor loadings >.40 and an eigenvalue of 5.62, which explained 40% of the total variance. In addition, known group comparisons provided further evidence for construct validity. There was no significant difference in BSES-SF scores in terms of demographic and obstetrics characteristics. CONCLUSION: Our results provide evidence that the German version of the BSES-SF is a reliable and valid tool for measuring breastfeeding self-efficacy among mothers in German-speaking countries.

Breastfeeding Self-Efficacy, Personal Well-Being and Related Factors in Pregnant Women Living in a District of Istanbul.

In this study, we examined breastfeeding self-efficacy levels, well-being and sociodemographic factors in pregnant women. The population of this descriptive study consisted of women with a pregnancy of 27 weeks or more in the Sultanbeyli district of Istanbul, Türkiye. A questionnaire was administered via telephone calls to pregnant women aged 18 years and older. The first part of the questionnaire included questions regarding breastfeeding history and sociodemographic information. The second part included the Prenatal Breastfeeding Self-Efficacy Scale, and the last part included the Personal Well-Being Scale. Higher scale scores indicate higher levels of self-efficacy and well-being. In total, 385 women participated in the study. The median age of the pregnant women was 28.0 years (18.0-43.0). The median gestational week was 33.0 (27.0-42.0). Among women who had received breastfeeding counseling, those with a higher level of knowledge about breastfeeding had higher breastfeeding self-efficacy (p < 0.05). Women with better economic status also had higher well-being scores (p < 0.05). There was a positive correlation between well-being and breastfeeding self-efficacy approaching the statistical significance level (p = 0.052). It is important to consider factors that may be associated with women's well-being and self-efficacy.

A Technological Approach to Improved Breastfeeding Rates and Self-Efficacy: A Randomized Controlled Pilot Study.

BACKGROUND: Breastfeeding confers significant maternal and infant benefits; however, breastfeeding rates remain suboptimal in the United States. A parent's decision to breastfeed is influenced by non-modifiable and modifiable factors, including breastfeeding knowledge and self-efficacy. There is a positive correlation between high maternal self-efficacy and breastfeeding duration. Parents increasingly rely on technology for health information. RESEARCH AIM: To determine if a smartphone application affected maternal self-efficacy and breastfeeding exclusivity rates. METHOD: This study was a randomized, controlled pilot study examining the effect of an educational program, included in a smartphone application, on breastfeeding self-efficacy (assessed in postpartum Week 1 and Weeks 4-6) and breastfeeding rates (assessed in postpartum Weeks 4-6). Forty participants were recruited using block randomization to intervention (17 of 20 completed the study) and usual care (19 of 20 completed the study) groups. To examine the pre-test/post-test difference in the Breastfeeding Self-Efficacy Scale - Short Form total scores, a change in score (post-intervention minus pre-intervention) was calculated for each parent. RESULT: The intervention group (phone application and usual care) showed greater change in self-efficacy scores (M = 7.6, SD = 7.8) compared to the control group (usual care; M = 1.2, SD = 3.7, p = .001). The rate of exclusive breastfeeding was nearly twice as high in the intervention group as in the control group, but did not reach statistical significance (p = .093). CONCLUSION: The investigators found enhanced breastfeeding self-efficacy and breastfeeding rates among postpartum women receiving a smartphone educational program in the first 6 weeks postpartum. Further studies on smartphone interventions will develop our understanding of this technology in improving breastfeeding rates.

Breastfeeding Self-Efficacy: A Systematic Review of Psychometric Properties Using COSMIN.

BACKGROUND: Breastfeeding self-efficacy has been proven to play a predictive role in enhancing breastfeeding initiation and continuation. Breastfeeding self-efficacy measurement tools have facilitated healthcare professionals' early identification and support of women at higher risk of early discontinuation of breastfeeding. RESEARCH AIM: The aim of this study was to assess the psychometric properties of breastfeeding self-efficacy measurement tools. METHOD: A systematic review was carried out in three phases. Phase One comprised a systematic literature review performed in PubMed, SCOPUS, Web of Science, and Cochrane Database of Systematic Reviews from February 2021 to January 2023, including 36 studies for final analysis. Phase Two provided a quality appraisal of the psychometric properties of each of the seven breastfeeding self-efficacy measurement tools, according to COnsensus-based Standards for the selection of health Measurement Instrument checklist (COSMIN) guidelines. Phase Three summarized and graded the overall quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) modified approach. RESULT: The included articles comprised 9,225 participants and seven breastfeeding self-efficacy measurement tools. The Breastfeeding Self-Efficacy Scale, Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF), and Prenatal Breastfeeding Self-Efficacy Scale were supported by Grade A evidence sustaining their validity and reliability to assess breastfeeding self-efficacy in the continuum of maternity care. The BSES-SF is the most feasible tool in clinical practice and the most utilized internationally, available in 15 languages. CONCLUSION: This systematic review provided a Grade A recommendation on breastfeeding measurement tools that will be helpful both for clinical and research purposes.Registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021238450).

Translation and Psychometric Evaluation of the Arabic Version of the Breastfeeding Self-Efficacy Scale-Short Form Among Women in the United Arab Emirates.

BACKGROUND: Breastfeeding self-efficacy as a construct has been theoretically and empirically linked to exclusive breastfeeding in studies globally using the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). However, its application in the Middle East and North Africa region is limited, as it has not been validated. RESEARCH AIMS: To psychometrically validate the BSES-SF among a sample of mothers in the United Arab Emirates. METHODS: We psychometrically evaluated the Arabic version of the BSES-SF using a sample of mothers (N = 457) residing in the United Arab Emirates. We used translation techniques, item-test and item-total correlations, confirmatory factor analysis, tests of reliability, and tests of validity. RESULTS: Item-test correlations of scale items ranged from 0.67 to 0.84, while item-total correlations ranged from 0.58 to 0.81. The confirmatory factor model assessed the 14-item scale to be unidimensional with satisfactory model fit indices. Our findings suggested the Arabic-language version of the BSES-SF was a reliable measure (α = 0.95) with strong construct and discriminant validity. BSES-SF scores significantly predicted exclusive breastfeeding (aOR = 1.04; 95% CI [1.02, 1.08]) and exclusive duration (ß = .06; 95% CI [0.4, 0.08]), which suggested strong predictive, validity after adjusting for parity, maternal age, maternal education, and study site. CONCLUSIONS: We have provided rigorous evidence that the BSES-SF is a valid and reliable measure of breastfeeding self-efficacy among Arabic-speaking women in the UAE. Interventions designed specifically to increase breastfeeding self-efficacy among Arabic-speaking women may be a mechanism to increase the suboptimal rates of breastfeeding exclusivity occurring in much of the MENA region.

Psychometric Assessment of the Breastfeeding Self-Efficacy Scale-Short Form: A Confirmatory Factor Analysis in Malawian Mothers.

BACKGROUND: Exclusive breastfeeding to 6 months postpartum has been related to breastfeeding self-efficacy in diverse populations. Globally, this is measured using the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). RESEARCH AIM: To evaluate the psychometric properties of the BSES-SF among women in Malawi; and to examine the relationship between breastfeeding self-efficacy and demographic and health factors. METHODS: The study design was a prospective, cross-sectional survey with a 2 week follow-up reliability check. Postpartum women (N = 180) were recruited at a maternity hospital in Lilongwe, Malawi. In addition to the BSES-SF, the World Health Organization's Quality of Life Scale (QoL) was also administered. Furthermore, confirmatory factor analysis, Cronbach's alpha, and Pearson's correlations were used to examine the construct validity, reliability, test-retest reliability, and convergent validity. RESULTS: The confirmatory factor analysis supported a unidimensional structure of the Malawian version of the 12-item BSES-SF. Cronbach's alpha and the intra-class correlation coefficient were 0.79 and 0.75, respectively. BSES-SF scores had significant correlation with QoL domains (physical QoL: r = 0.31, p < .001; and environmental QoL: r = 0.22, p < .01). Participants' age, parity, and mode of delivery were positively correlated with breastfeeding self-efficacy scores. CONCLUSION: The findings of our study confirmed that the 12-item BSES-SF is a reliable and valid scale for assessing women's breastfeeding self-efficacy in Malawi.

A Pilot Randomized Controlled Trial of an Online Educational Program for Primiparous Women to Improve Breastfeeding.

BACKGROUND: There are different approaches to breastfeeding interventions, but the global 6-month exclusive breastfeeding rates remain suboptimal. The COVID-19 pandemic has brought extra difficulties in promoting breastfeeding. RESEARCH AIM: To test the feasibility and effectiveness of a theory-based, real-time online educational and support program for breastfeeding related outcomes. METHODS: An assessor-blinded, prospective pilot randomized controlled trial with parallel-group, repeated-measures design was used. The sample was low-risk primiparous mothers (N = 40) who delivered in the local public hospitals. Study outcomes consisted of exclusive breastfeeding rate, breastfeeding self-efficacy, and other breastfeeding outcomes measured by a self-reported questionnaire, including the Breastfeeding Self-Efficacy Scale and the Edinburgh Postnatal Depression Scale. Comparisons between the differences in the intervention and control groups were carried out. RESULTS: Thirteen participants in the intervention group successfully completed the program. They had a higher exclusive breastfeeding rate, breastfeeding self-efficacy, breastfeeding initiation rate, and longer exclusive breastfeeding duration than the control group. Additionally, the intervention group had a lower partial breastfeeding rate, and a higher maternal postnatal depression score and infant's morbidity at postnatal 2 months. However, all the results were not statistically significant (p > .050). Overall, the intervention was highly valued by all participants who appreciated the regular postnatal follow-ups. CONCLUSIONS: Despite showing the satisfactory feasibility of the program, no significant improvements were found in all study outcomes. Considering the participants' comments, we suggest refining and further testing the intervention with a larger sample size over a longer-term follow-up to confirm its effectiveness.This study has been registered at ClinicalTrials.gov (NCT04741425).

Bristol Breastfeeding Assessment Tool-Thai Version: Translation, Validity, and Reliability.

BACKGROUND: In 2019, 14.0% of infants in Thailand were exclusively breastfed up to 6 months of age. To increase exclusive breastfeeding, an objective assessment measure would be useful to maternity care providers for appraising the problems encountered by new mothers' experiences with breastfeeding. RESEARCH AIMS: To translate the Bristol Breastfeeding Assessment Tool from English into Thai; to assess the reliability and validity of the Thai Bristol Breastfeeding Assessment Tool; and to explore the relationship of a mother's self-efficacy to successful breastfeeding. METHODS: Using a methodological design, we purposively sampled 302 new mothers from two tertiary hospitals in Thailand who had given birth to a single baby with an uncomplicated vaginal birth. The Thai Bristol Breastfeeding Assessment Tool's structure was examined using confirmatory factor analysis. Concurrent and convergent validity were assessed using the Thai LATCH instrument and Thai Breastfeeding Self-Efficacy Scale, respectively. RESULTS: The inter-item Thai Bristol Breastfeeding Assessment Tool correlation coefficients were positive and strong. The correlation between scores of the Thai Bristol Breastfeeding Assessment Tool and Thai LATCH instrument were positive and strong and had acceptable concurrent validity. The confirmatory factor analysis model fit the Thai Bristol Breastfeeding Assessment Tool data perfectly and the Cronbach's alpha coefficient had acceptable internal reliability. CONCLUSIONS: The Thai Bristol Breastfeeding Assessment Tool is a cross-culturally translated instrument equivalent to its English version and demonstrated acceptable validity and reliability. The instrument provides a mechanism for an objective assessment and monitoring system of optimal breastfeeding practices in Thai mothers with newborns.

Body Image Dissatisfaction, Breastfeeding Experiences, and Self-Efficacy in Postpartum Women with and Without Eating Disorder Symptoms.

BACKGROUND: Women during the postpartum period undergo significant changes which affect body image, eating behaviors, and, potentially, breastfeeding. There is limited research about relationships among these variables, particularly related to breastfeeding experiences and self-efficacy. RESEARCH AIMS: To determine: (1) the associations between eating disorder symptoms and body image, breastfeeding self-efficacy, and breastfeeding experiences; and (2) the differences in body image, breastfeeding self-efficacy, breastfeeding experiences, and breastfeeding status of postpartum women with and without clinically significant eating disorder symptoms. METHODS: A secondary data analysis using a 2-group correlational, cross-sectional online survey design was used. Participants with infants 2-6 months old who had breastfed their infant at least once (N = 204) were recruited nationally to complete a cross-sectional survey assessing breastfeeding and postpartum physical and mental health using validated measures. Linear and logistic regression evaluated differences between participants with and without eating disorder symptoms regarding their body image, breastfeeding experience and self-efficacy, and breastfeeding status (continued vs. discontinued) at 2 months postpartum. RESULTS: Clinical eating disorder symptoms were reported by 9.8% (n = 20). Participants with clinical eating disorder symptoms reported lower appearance evaluations (B = -0.53, 95% CI [-0.93, -0.14]) and body image satisfaction (B = -0.55, 95% CI [-0.87, -0.23]); reduced odds of breastfeeding at 2 months postpartum (AOR = 0.15, 95% CI [0.04, 0.56]); and lower breastfeeding self-efficacy (B = -7.70, 95% CI [-14.82, -0.58] relative to participants without clinical symptoms. No differences between groups were observed for breastfeeding experiences. CONCLUSIONS: Participants with clinically significant eating disorder symptoms are at risk for early breastfeeding discontinuation and lower breastfeeding self-efficacy. Our findings have implications for future research and clinical care practices, including screening for body image concerns and eating disorder symptoms and supporting breastfeeding self-efficacy.

Psychometric Assessment of the Paternal Breastfeeding Self-Efficacy Scale-Short Form: A Confirmatory Factor Analysis of Malawian Fathers.

BACKGROUND: Only 61% of Malawian women exclusively breastfeed to the recommended 6 months. Paternal support is predictive of exclusive breastfeeding, and significantly related to paternal breastfeeding self-efficacy, defined as fathers' confidence in their ability to assist mothers with breastfeeding. RESEARCH AIMS: To (1) examine the psychometric properties of the Paternal Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) in Malawian fathers, including internal consistency reliability, test-retest reliability, construct validity using Confirmatory Factor Analysis (CFA), and convergent validity; and (2) assess the relationship between the BSES-SF and paternal demographic and health factors. METHODS: A cross-sectional study was conducted at a maternity hospital in Lilongwe, Malawi, and 180 fathers whose partners had delivered a singleton infant were included. Participants completed the Breastfeeding Self-Efficacy Scale and Quality of Life with confirmatory factor analysis performed to assess the construct validity. The internal consistency reliability and test-retest reliability were evaluated using Cronbach's alpha coefficient and intra-class correlations. Convergent validity was also assessed. RESULTS: A unidimensional factorial structure of the Malawian Paternal BSES-SF was identified using confirmatory factor analysis. The scale had an excellent Cronbach's alpha of .90 and a test-retest reliability of .93. Participants' breastfeeding self-efficacy was significantly correlated with the Quality of Life domains of psychological health (r = .23; p < .01), social relationships (r = .28; p < .001), and environmental health (r = .30; p < .001). Participants who were older, married, and with ≥ two children had significantly higher breastfeeding self-efficacy and were more confident in their ability to support their partner's breastfeeding. CONCLUSION: The Paternal Breastfeeding Self-Efficacy Scale-Short Form was a valid and reliable measure to assess fathers' confidence in their ability to assist mothers with breastfeeding in Malawi.

Randomized Clinical Trial of a Prenatal Breastfeeding and Mental Health Mixed Management Intervention.

BACKGROUND: The continuity of maternal depressive symptoms throughout the perinatal period and breastfeeding problems have adverse influences on breastfeeding. RESEARCH AIM: To compare the feeding patterns and breastfeeding experiences, maternal health and mental health, and breastfeeding self-efficacy between women with depressive symptoms who participated in a prenatal individualized mixed management intervention and those who received usual care. METHODS: Chinese primigravida (N = 182) with an Edinburgh Postnatal Depression Scale score ≥ 9 in late pregnancy (≥ 28 weeks and < 35 weeks) were randomly assigned to the intervention group (n = 84) or the control group (n = 84). Intervention group participants received four sessions of individualized mixed management combining psycho-education and breastfeeding education. Breastfeeding self-efficacy, feeding patterns, maternal depression, and health status were evaluated in both groups. RESULTS: Significant differences were noted between the groups in breastfeeding self-efficacy at 42 days postpartum (p < .05) and feeding patterns at 3 months and 6 months postpartum (p < .05). Repeated measures analysis of variance showed significant differences in the EPDS scores between groups at three postpartum time points (p < .05). The intervention group had significantly lower postpartum depression as diagnosed by the MINI (p < .05). CONCLUSIONS: A prenatal individualized mixed management intervention holds promise as an effective prevention and health promotion program addressing breastfeeding outcomes and maternal mental health.This RCT was registered (ChiCTR-IOR-17013761) with Chinese Clinical Trial Registry, http://www.chictr.org.cn/enIndex.aspx on 12/7/2017.

Associations Between Single-Family Room Care and Breastfeeding Rates in Preterm Infants.

BACKGROUND: Hospitalization in neonatal intensive care units with a single-family room design enables continuous maternal presence, but less is known regarding the association with milk production and breastfeeding. RESEARCH AIM: To compare maternal milk production, breastfeeding self-efficacy, the extent to which infants received mother's milk, and rate of direct breastfeeding in a single-family room to an open bay neonatal intensive care unit. METHODS: A longitudinal, prospective observational study comparing 77 infants born at 28- 32° weeks gestational age and their 66 mothers (n = 35 infants of n = 30 mothers in single family room and n = 42 infants of n = 36 mothers in open bay). Comparisons were made on milk volume produced, the extent to which infants were fed mother's milk, and rate of direct breastfeeding from birth to 4 months' corrected infant age. Breastfeeding self-efficacy was compared across mothers who directly breastfed at discharge (n = 45). RESULTS: First expression (6 hr vs. 30 hr, p < .001) and first attempt at breastfeeding (48 hr vs. 109 hr, p < .001) occurred significantly earlier, infants were fed a greater amount of mother's milk (p < .04), and significantly more infants having single-family room care were exclusively directly breastfed from discharge until 4 months' corrected age; OR 6.8 (95% CI [2.4, 19.1]). Volumes of milk produced and breastfeeding self-efficacy did not differ significantly between participants in either units. CONCLUSION: To increase the extent to which infants are fed mother's own milk and are exclusively directly breastfed, the design of neonatal intensive care units should facilitate continuous maternal presence and privacy for the mother-infant dyad.

Psychometric properties of the modified breastfeeding self-efficacy scale-short form (BSES-SF) among Chinese mothers of preterm infants.

OBJECTIVE: Preterm mother-infant dyads face more challenges than healthy term infants in breastfeeding initiation and continuation due to maternal health status, preterm infant's immaturity or comorbidities, and breastfeeding policy of the neonatal units. Breastfeeding self-efficacy affects breastfeeding outcomes in preterm infants. No specific instrument in Chinese is available to assess maternal breastfeeding self-efficacy of preterm infants. This study aims to assess the psychometric characteristics of the modified Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) among Chinese mothers of preterm infants. DESIGN: A cross-sectional study was conducted. SETTING: Two tertiary hospitals in China. PARTICIPANTS: A total of 153 women who gave birth before 37 weeks of gestation. MEASUREMENTS: The instrument was translated and back translated. The internal consistency reliability was investigated using Cronbach's alpha coefficient. The content validity, construct validity, and criterion validity were conducted to evaluate the validity of the scale. Exploratory factor analysis was used to investigate the factor structure. FINDINGS: The scale had good reliability with Cronbach´s alpha above the acceptable level of 0.7. The Item-Content Validity Index (I-CVI) ranged from 0.800 to 1.000, and the Scale-Content Validity Index (S-CVI) is 0.950. The principal component analysis revealed the presence of two factors with eigenvalues greater than 1, explaining a total variance of 74.665%. The modified BSES-SF scores were correlated with women's parity, breastfeeding knowledge, previous breastfeeding experience, perceived support from the spouse and health professionals, and amounts of expressed milk. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The Chinese version of modified BSES-SF is a reliable, valid screening instrument to evaluate the maternal breastfeeding self-efficacy of preterm infants. It is recommended to provide interactive, face-to-face breasting education and support to help mothers of preterm infants maintain high level of breastfeeding self-efficacy and further to achieve satisfactory breastfeeding outcomes.

Measuring paternal breastfeeding self-efficacy: A psychometric evaluation of the Breastfeeding Self-Efficacy Scale-Short Form among fathers.

The majority of women discontinue breastfeeding before the recommended 6 months postpartum. If health professionals are to improve breastfeeding outcomes, predisposing factors amenable to intervention need to be identified. One possible risk factor to target is breastfeeding self-efficacy, which has been shown to significantly influence breastfeeding outcomes. The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) was originally designed to assess a mother's confidence in her ability to breastfeed. Fathers play an important role in supporting their breastfeeding partner and their self-efficacy may also influence breastfeeding outcomes. However, it is unknown if the BSES-SF is a valid and reliable measure for measuring self-efficacy among fathers. The goal of this study is to assess the psychometric properties of the BSES-SF among fathers. Fathers (n=214) whose partners were breastfeeding were recruited from a large hospital in Toronto, Canada. Fathers completed the modified BSES-SF in-hospital and at 6 weeks postpartum. The unidimensional structure of the BSES-SF was confirmed, with the best model fit found at 6 weeks. Cronbach's alpha coefficient was 0.91 at baseline and 0.92 at 6 weeks. Paternal BSES-SF scores were significantly correlated with maternal BSES-SF scores, fathers' breastfeeding attitude, importance fathers place on breastfeeding, breastfeeding level and exclusivity, and perception of breastfeeding progress. While paternal in-hospital BSES-SF scores did not predict breastfeeding at 6 and 12 weeks, 6 week BSES-SF scores predicted exclusivity at 12 weeks. This study provides initial evidence that the modified BSES-SF is a valid and reliable measure of breastfeeding self-efficacy among fathers, especially when used following hospital discharge.

Influência da autoconfiança materna sobre o aleitamento materno exclusivo aos seis meses de idade: uma revisão sistemática / Influence of maternal confidence on exclusive breastfeeding until six months of age: a systematic review

Resumo A amamentação é uma prática diretamente relacionada com a saúde da mãe e, principalmente, do bebê. Apesar de ser um processo natural, muitas mães relatam dificuldades. Este estudo objetivou buscar evidências científicas sobre a questão: "Mãe com mais confiança consegue amamentar exclusivamente por 6 meses?". Foi realizada uma revisão sistemática com busca em 5 bancos de dados eletrônicos, que resultou na inclusão de 4 estudos de coorte para avaliação. Realizou-se uma análise qualitativa dos resultados, porém não foi possível fazer a meta-análise. Autoconfiança em amamentar foi avaliada pela escala "Breastfeeding Self-Efficacy Scale". Os estudos analisados mostraram que há associação estatística significante entre aleitamento materno exclusivo e autoconfiança em amamentar. A utilização da escala parece ser uma ferramenta confiável para identificar mães em risco para desmame precoce, facilitando o planejamento de ações pelos profissionais em saúde. As evidências obtidas mostraram a associação entre mães com maior confiança em amamentar e a amamentação exclusiva por 6 meses, porém estes resultados não podem ser generalizados devido à heterogeneidade das populações.

Abstract Breastfeeding is a practice directly related to the health of the mother and especially the baby. Despite being a natural process, many mothers report difficulties with breastfeeding. This study aimed to seek scientific evidence on the issue: "Can a mother with more confidence in breastfeeding exclusively breastfeed her baby for 06 months?". We conducted a systematic review with a search in five electronic databases, and included four cohort studies for evaluation. We conducted a qualitative analysis of the results, considering the methodological differences and lack of data, and were unable to perform meta-analysis. Confidence in breastfeeding was evaluated by using the Breastfeeding Self-Efficacy Scale. The studies analyzed showed statistically significant association between the practice of breastfeed and confidence in breastfeeding. The application of a scale to evaluate trust and identify mothers at risk for early weaning appeared to be a reliable measurement tool, capable of facilitating action planning by health professionals. The evidence showed association between mothers with higher levels of confidence in breastfeeding and exclusive breastfeeding for 6 months, but these results could not be generalized because of the heterogeneity of the population.

The Swedish Version of the Breastfeeding Self-Efficacy Scale-Short Form: Reliability and Validity Assessment.

BACKGROUND: Among Swedish mothers, breastfeeding duration has been declining in recent years. An instrument for early identification of women at risk for shorter breastfeeding duration may be useful in reversing this trend. OBJECTIVES: The aims of this study were to translate and psychometrically test the Swedish version of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), examine the relationship between breastfeeding self-efficacy and demographic variables, and evaluate associations with breastfeeding continuation plans in Swedish mothers. METHODS: The BSES-SF was translated into Swedish using forward and back translation. The sample consisted of 120 mothers who, during the first week postpartum, came for a routine follow-up visit at the postnatal unit in a university hospital. The mothers were compared based on demographic data and their future breastfeeding plans. RESULTS: The Cronbach's alpha coefficient for internal consistency for the BSES-SF was 0.91 and the majority of correlation coefficients exceeded 0.3. A 1-factor solution was found that explained 46% of the total variance. There was no difference in confidence in breastfeeding between mothers with early hospital discharge and mothers who received postnatal care at the hospital. Primiparas who stayed longer at the hospital were less confident in breastfeeding than primiparas who had a shorter hospital stay. Breastfeeding mothers who planned to partially breastfeed in the near future had lower BSES-SF scores, compared to those who planned to continue exclusive breastfeeding. CONCLUSION: The Swedish version of the BSES-SF has good reliability, validity, and agreement with mothers' plans regarding breastfeeding continuation and exclusivity.