241489 Breastfeeding-Friendly Healthcare (BFHC) Project: Assessing the Construct Validity of A Tool Measuring Breastfeeding-Friendliness in Hospitals

Tuesday, November 1, 2011

Nathan C. Nickel, MPH , Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health at the University of North Carolina-Chapel Hill, Chapel Hill, NC
Emily C. Taylor, MPH, CD(DONA), LCCE , Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, School of Public Health, University of North Carolina, Chapel Hill, NC
Miriam Labbok, MD, MPH, FACPM, IBCLC, FABM , Carolina Global Breastfeeding Institute, Department of Maternal Child Health, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC
BACKGROUND Increasing breastfeeding-friendly practices in hospitals is an objective of Healthy People 2020. Assessment of breastfeeding-friendliness is important to achieving this objective. This study explores the construct validity of the Breastfeeding Friendly Healthcare Project (BFHC) Electronic Survey (E-Survey) for assessing breastfeeding-friendliness. METHODS BFHC staff developed an E-Survey using questions from the CDC mPINC and previously tested instruments. BFHC staff distributed the E-Survey to maternity staff. The authors used Exploratory Factor Analysis with oblique oblimin rotation to assess the instrument's construct validity. The authors retained extracted factors with Eigen Values greater than or equal to one. Item-factor correlations assessed correlations between each item and its assigned factor. RESULTS The E-Survey had 933 respondents. Factor analyses showed the E-Survey measured two constructs related to breastfeeding-friendliness: “Teaching/Counseling Moms About Breastfeeding” and “Care Provided Infants”. Individual items on the “Teaching Moms” construct correlated with the construct at 0.73 or higher. Overall Cronbach's Alpha for “Teaching” was 0.72. Individual items on the “Care Provided Infants” construct correlated with the construct at 0.70 or higher. Overall Cronbach's Alpha for “Care Provided Infants” was 0.51. CONCLUSIONS Item-factor correlations and the overall Cronbach's Alpha for the Teaching construct demonstrate the E-Survey reliably measures breastfeeding-friendliness vis-à-vis “Teaching/Counseling Moms About Breastfeeding”. Item-factor correlations for the second construct suggest the E-Survey may reliably measure breastfeeding-friendliness related to “Care Provided Infants”, although the Cronbach's Alpha for this factor is marginal. This tool may be useful to hospitals wishing to assess their breastfeeding-friendliness as they respond to Healthy People 2020.

Learning Areas:
Administration, management, leadership
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Program planning
Public health or related research

Learning Objectives:
Assess the construct validity of an instrument designed to assess breastfeeding-friendliness in hospitals. Assess the applicability of the discussed instrument in measuring hospital-level breastfeeding-friendliness across multiple contexts. Explain methods for assessing the construct validity of an instrument. Compare the proposed instrument with other instruments measuring breastfeeding-friendliness. Discuss the value of the proposed instrument in helping hospitals achieve the Healthy People 2020 objective. Discuss the value of the proposed instrument in helping hospitals answer the Surgeon General's Call to Action To Support Breastfeeding.

Keywords: Health Care Quality, Breastfeeding

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am trained in monitoring and evaluation. I have worked with the Breastfeeding Friendly Healthcare Project for two years. I, along with the co-authors, designed the instrument. I conducted the data analyses.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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