Development and validation of the breastfeeding self-regulation questionnaire (BSRQ) to assess maternal breastfeeding motivation

Abstract

Although most new mothers are aware of the benefits of breastfeeding, many stop breastfeeding early in the postpartum period. Maternal psychosocial factors have been shown to contribute to early breastfeeding cessation. According to Self-Determination Theory (SDT), maternal self-regulated motivations are indispensable factors in studying maternal commitment to breastfeed. This thesis presents a research study that consisted of two phases. In the first phase, the study aim was to develop and assess the psychometric properties of the Breastfeeding Self -Regulation Questionnaire (BSRQ) for Chinese pregnant women in Hong Kong. In the second phase, the validated BSRQ was used to examine the relationship between maternal self-regulated motivations toward breastfeeding and the actual breastfeeding duration in a cohort of new mothers in Hong Kong. In the first phase of the study, the literature was reviewed and items were derived for a preliminary version of the BSRQ. Thirty-five context-specific items in English were generated. The items were translated into Chinese and then back translated into English following established translation procedures. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed to assess the structure of the questionnaire. Predictive validity was measured by assessing the relationship between the BRSQ sub-scales and total scores and actual duration of breastfeeding. Five hundred and ninety-one participants were recruited from three publicly funded antenatal clinics. Of the 35 items in the preliminary BSRQ, 22 were retained by EFA. CFA revealed 5 factors, including intrinsic, identified, integrated, introjected and external regulations. The goodness of fit of the CFA model was adequate. The Cronbach’s alpha of the BSRQ was 0.86. For every one-point increase in the BSRQ score, participants had 5% higher odds of any breastfeeding (OR=1.05, 95%CI 1.02-1.08) at 6 weeks postpartum. Similarly, every one-point increment in intrinsic regulation score was associated with 18% higher odds of exclusive breastfeeding at 6 weeks postpartum (OR=1.18, 95% CI 1.03-1.34). In the second phase of the study, 501 participants who gave birth in two obstetrics units of two publicly funded hospitals were recruited and asked to fill out the Chinese BSRQ at baseline visits. The participants were contacted via telephone at 6 and 12 weeks postpartum to determine their breastfeeding status. Logistic regression was used to assess the association between breastfeeding exclusivity and BSRQ sub-scales and total scores. The odds of continuing exclusive breastfeeding at 6 weeks postpartum increased by 15% (adjusted OR=1.15, 95% CI 1.02-1.29) for every one increment increase in the intrinsic regulation score. A one-unit increase in the integrated regulation score was associated with a 8% increase in the odds of continuing any breastfeeding (adjusted OR=1.08, 95%CI 1.02-1.14) at 12 weeks postpartum. In conclusion, it was feasible to assess maternal self-regulated and externally controlled motivations toward breastfeeding using a valid, reliable BSRQ. Maternal self-regulated motivations were essential factors in determining breastfeeding duration and exclusivity.