A group of researchers from the Faculties of Health Sciences and Psychology at the University of La Laguna and the Canary Islands Health Service has published in the journal Midwifery an article This study analyzes the internal structure of the scale used to measure breastfeeding self-efficacy, revealing three fundamental components: security, competence, and motivation. Identifying these components separately will allow for an individualized assessment of each mother's profile, enabling healthcare professionals to design breastfeeding support interventions tailored to each individual.
Signed by Coral Castro Cuervo, Aythamy González Darias, José Miguel Díaz Gómez, Irene Cabrera Ramírez and Marta Díaz Gómez, The study analyzes the validated scale for measuring mothers' self-efficacy in breastfeeding, called Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). This self-efficacy can be defined as the belief in one's own abilities to achieve a goal or perform a task, in this case, breastfeeding. It influences mothers' responses (effort and thoughts) to difficulties that may arise at the beginning or during breastfeeding and is influenced, among other factors, by previous breastfeeding experience and the level of support the mother receives from her partner and healthcare professionals.
Breastfeeding has protective effects on the health of both mothers and infants, offering the latter an optimal start in life, the most appropriate development, and protection against disease. In recent years, exclusive breastfeeding rates at 6 months have been increasing in Spain, from 28.1% in 2011 to 39.1% in 2017. However, the World Health Organization's target of at least 50% of infants receiving exclusive breastfeeding at 6 months has not yet been reached. To achieve this, it is important to identify the modifiable factors that influence the initiation and maintenance of breastfeeding; hence the importance of the BSES-SF scale.
It is known that one of these factors is the aforementioned self-efficacy of mothers in breastfeeding, which, according to previous studies, the stronger their perception, the greater the effort to maintain and prolong breastfeeding, which explains why there is an association between self-efficacy and breastfeeding rates.
Study in Tenerife and Lanzarote
This study aimed to explore the internal structure of the BSES-SF scale to determine if its items could be grouped into different components, and to analyze whether its score changes during the first months of breastfeeding and whether it is related to early cessation of breastfeeding. The study was conducted at the University Hospital of the Canary Islands (Tenerife) and the Doctor José Molina Orosa University Regional Hospital (Lanzarote), with the participation of 272 first-time mothers. At 48 hours postpartum and at 3 and 6 months, the type of breastfeeding, the breastfeeding self-efficacy scale, and other sociodemographic and clinical variables were recorded.
Corroborating previous studies, the research group found that the BSES-SF scale score increased throughout breastfeeding. The increase was greater in mothers who exclusively or predominantly breastfed. They also found that it was possible to differentiate three components on the scale: breastfeeding confidence, competence in coping with breastfeeding and its potential difficulties, and motivation to breastfeed.
The motivation component was the most stable of the three, with no significant changes throughout the follow-up period. The safety component initially had low values and increased rapidly between 3 and 6 months, possibly related to the mothers gaining experience.
On the other hand, both the safety and competence components reached significantly higher values at 3 months in study participants who continued exclusive breastfeeding compared to those who had switched to partial breastfeeding, that is, those who supplemented breast milk with infant formula. According to the study, the competence component is the best predictor of continued breastfeeding at 6 months, with an even greater influence than maternal education level, a factor that has been shown to be related to the duration of breastfeeding in numerous previous studies.
Based on these results, the research group believes that interventions to improve breastfeeding rates should be focused on mothers at higher risk of early cessation of breastfeeding, and include strategies based on the individual needs of mothers, focusing especially on those aimed at empowering them and increasing their level of competence.
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