Validation of the Arabic version of the breastfeeding behavior questionnaire among Lebanese women

BACKGROUND

The Breastfeeding Behavior Questionnaire (BBQ) assesses women's perceptions of their breastfeeding behavior. It was adapted to several languages and used in different settings, but has not been validated in Arabic-speaking populations. None of the previous studies that used the BBQ in other cultures examined its ability to predict the actual breastfeeding behaviors of mothers postpartum. This study validated the BBQ in a cohort of Lebanese pregnant women between December 2013 and January 2016, and examined whether it can predict exclusive breastfeeding at one, three and six months.

METHODS

The internal consistency reliability and construct validity of the Arabic BBQ (BBQ-A) were tested on 354 pregnant women. Its predictive ability was assessed by correlating the women's BBQ-A scores with their breastfeeding outcomes at one, three and six months post-delivery.

RESULTS

The BBQ-A had a good internal consistency reliability (Cronbach's alpha = 0.78). Exploratory factor analysis revealed that it is unidimensional. Inter-item correlations ranged between - 0.016 and 0.934, with corrected-item total correlations ranging from 0.273 to 0.678. Perceived positive breastfeeding behavior correlated with positive breastfeeding attitudes, good breastfeeding knowledge and stronger breastfeeding intention supporting its external validity. However, in binomial multivariate logistic regression analysis, the BBQ-A did not predict exclusive breastfeeding at one, three or six months.

CONCLUSIONS

The BBQ-A is a reliable and valid instrument to assess women's perceptions of their breastfeeding behavior in an Arab context. Availability of this instrument is important for investigators conducting breastfeeding research in the Arab world. However, the BBQ-A does not predict exclusive breastfeeding at one, three or six months. Further research on the Breastfeeding Behavior Questionnaire is needed to examine its predictive validity in other cultures.

A multi-component intervention to support breastfeeding in Lebanon: A randomized clinical trial

Background

Effective evidence-based breastfeeding support interventions can bolster breastfeeding practices. This study investigated the effect of a multi-component breastfeeding support intervention delivered in hospital and home settings on six-month exclusive breastfeeding (EBF) relative to standard care.

Methods

This is a parallel group, randomized clinical trial, in which 362 healthy pregnant women with singleton pregnancy were randomly allocated to a multi-component intervention that included antenatal breastfeeding education, professional, and peer support, delivered in hospital and home settings for six months (experimental, n = 174), or to standard care (control, n = 188). The primary outcome was six-month EBF rate. Secondary outcomes were exclusive and any breastfeeding rates at one and three months, maternal breastfeeding knowledge, attitude, and behavior at six months, and satisfaction with the intervention.

Results

The crude six-month EBF rate was similar in both groups (35.2% vs. 28.1% in the experimental and control groups, respectively, p = 0·16). In adjusted analysis, six-month exclusivity was twice as likely in the experimental group relative to standard care (OR = 2.02; 95%CI: 1.20 to 3.39); whereas the odds for any breastfeeding were similar. Participants compliant with all three components were six times more likely to practice EBF for six months relative to standard care (OR = 6.63; 95% CI: 3.03 to 14.51). Breastfeeding knowledge of the experimental group, at six months, was significantly improved compared to the control. No changes were observed in breastfeeding attitude or behavior.

Conclusions

Combining education with peer and professional breastfeeding support improved six-month breastfeeding exclusivity and knowledge.

Validation of the Arabic Version of the Infant Feeding Intentions Scale Among Lebanese Women

BACKGROUND

The Infant Feeding Intentions (IFI) scale was shown to reliably measure maternal intentions to initiate breastfeeding and continue exclusive breastfeeding until 1, 3, or 6 months in English and Spanish but not in Arab contexts. Research aim: This study aimed to validate an Arabic version of the IFI scale (IFI-A) and examine its ability to predict exclusive breastfeeding at 1, 3, or 6 months in pregnant Lebanese women.

METHODS

The internal consistency reliability and construct validity of the IFI-A scale were tested on 50 pregnant women (Group 1), whereas its predictive ability was tested on 196 pregnant women (Group 2), who were surveyed monthly about their infants' nutrition method until 6 months.

RESULTS

The IFI-A scale's Cronbach's alpha internal consistency reliability is .82. Its corrected item-total correlations ranged from .26 for Item 2 ("at least give breastfeeding a try") to .86 for Item 4 ("will be exclusively breastfeeding at 3 months"). Exploratory factor analysis revealed that it is unidimensional. IFI-A scores correlated significantly with exclusive breastfeeding duration in Group 1 ( r = .624; p = .001) and with participants' breastfeeding attitude ( r = .390; p < .001) and previous breastfeeding duration ( r = .237; p = .011) in Group 2, thus confirming its external construct validity. In adjusted analysis, the IFI-A scale predicted exclusive breastfeeding at 3 months, albeit weakly (odds ratio = 1.16; 95% confidence interval [0.99, 1.36]), but not at 1 or 6 months.

CONCLUSION

The IFI-A scale is a reliable and valid tool to assess maternal feeding intentions and predict exclusive breastfeeding at 3 months in the Arab context. Further studies are needed in other Arab contexts to confirm our findings.

Adaptation and Validation of the Arabic Version of the Infant Breastfeeding Knowledge Questionnaire among Lebanese Women

BACKGROUND

Valid instruments that can reliably assess maternal breastfeeding knowledge in Arabic-speaking populations are nonexistent. The availability of such an instrument is essential for investigators working in this field.

OBJECTIVE

This study aimed to describe the adaptation and validation of the Arabic Breastfeeding Knowledge Questionnaire (BFK-A) from the original 20-item English version.

METHODS

A translated version of the 20-item BFK was validated among 417 Lebanese women after pilot testing for clarity, comprehension, length, and cultural appropriateness. Exploratory factor analysis was run to examine dimensionality of the instrument and Kuder-Richardson-20 (KR-20) was used to assess its internal consistency.

RESULTS

The BFK-A is a unidimensional scale with acceptable internal consistency reliability (KR-20 = 0.652) after the exclusion of 4 items. Higher breastfeeding knowledge levels were strongly and statistically significantly associated with higher mean scores for the validated Arabic Iowa Infant Feeding Attitude Scale ( P < .001), thus confirming its construct validity.

CONCLUSION

The Arabic 16-item BFK-A has an acceptable reliability, similar to the original instrument. Further studies are encouraged to confirm the validity of the 16-item BFK-A among other Arab populations. There is also a need to develop more reliable instruments to use in lactation research in this context.