DEVELOPMENT AND VALIDATION OF KNOWLEDGE AND INTENTION TO BREASTFEED DURING PANDEMIC QUESTIONNAIRE USING EXPLORATORY FACTOR ANALYSIS AND RASCH MODEL
Breastfeeding during the COVID-19 pandemic is challenging. Strong intention and good knowledge on the risk and benefit of breastfeeding are important for a woman to breastfeed her child during this period. This study aims to develop and validate a Malay language questionnaire in order to measure Malaysian women's knowledge and intention about breastfeeding during the pandemic. The items were developed based on an extensive review of literature as well as breastfeeding guidelines and suggestions from experts, followed by an assessment of content and face validity that involved nine and 30 reviewers respectively. A pilot study was conducted on 90 respondents and the reliability assessment was performed using Rasch analysis. Exploratory factor analysis (EFA) was used to determine the number of latent factors within the intention dimension. Among 29 knowledge items and 36 intention items, 19 knowledge items remained with a person separation (person reliability) as well as item separation (item reliability) of 1.73(0.75) and 3.97(0.94). The final intention domain had 17 items with a person separation (person reliability) as well as item separation (item reliability) of 1.54(0.70) and 3.87(0.94). Three latent factors were identified within the intention questionnaire. The final 17 items explained 53.7% of the variance with an overall Kaiser-Meyer-Olkin measure of sampling adequacy of 0.70, χ2 = 623.40 (136), p<0.001. Using the framework of the theory of planned behaviour, the drafted questionnaire is reliable and valid based on the Rasch measurement model to measure the knowledge and intention about breastfeeding during an infection outbreak.
Horta, B.L. Breastfeeding: investing in the future. Breastfeeding Medicine 14, S-11-S-12 (2019).
Moreno, M.A., Furtner, F. & Rivara, F.P. Breastfeeding as obesity prevention. Archives of Pediatrics & Adolescent Medicine 165, 772-772 (2011).
Schulze, P.A. & Carlisle, S.A. What research does and doesn’t say about breastfeeding: A critical review. Early Child Development Care 180, 703-718 (2010).
Horta, B.L., Loret de Mola, C. & Victora, C.G. Breastfeeding and intelligence: a systematic review and meta-analysis. 104, 14-19 (2015).
Kotsopoulos, J., et al. Breastfeeding and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers. Breast cancer research 14, 1-7 (2012).
Oliveira, L.V.d., Silva, C.R.A.C.d., Lopes, L.P. & Agra, I.K.R. Current evidence of SARS-CoV-2 vertical transmission: an integrative review. Revista da Associação Médica Brasileira 66, 130-135 (2020).
Bwire, G.M., Njiro, B.J., Mwakawanga, D.L., Sabas, D. & Sunguya, B.F. Possible vertical transmission and antibodies against SARS‐CoV‐2 among infants born to mothers with COVID‐19: A living systematic review. Journal of medical virology 93, 1361-1369 (2021).
Li, Y., et al. Lack of vertical transmission of severe acute respiratory syndrome coronavirus 2, China. Emerging infectious diseases 26, 1335 (2020).
Liu, W., et al. Clinical characteristics of 19 neonates born to mothers with COVID-19. Frontiers of medicine 14, 193-198 (2020).
Fan, C., et al. Perinatal Transmission of 2019 Coronavirus Disease–Associated Severe Acute Respiratory Syndrome Coronavirus 2: Should We Worry? Clinical Infectious Diseases 72, 862-864 (2021).
Alzaheb, R.A. A review of the factors associated with the timely initiation of breastfeeding and exclusive breastfeeding in the Middle East. Clinical medicine insights: pediatrics 11, 1179556517748912 (2017).
Stuebe, A. Should Infants Be Separated from Mothers with COVID-19? First, Do No Harm. Breastfeeding Medicine 15, 351-352 (2020).
Spatz, D.L., et al. Promoting and Protecting Human Milk and Breastfeeding in a COVID-19 World. Frontiers in pediatrics 8, 1000 (2021).
Centers for Disease Control (CDC). Evaluation and management considerations for neonates at risk for COVID-19. Vol. 2021 (Centers for Disease Control (CDC), 2020).
World Health Organization. Breastfeeding and COVID-19: scientific brief, 23 June 2020. (World Health Organization, Geneva, 2020).
Linares, A.M., et al. Intention to breastfeed as a predictor of initiation of exclusive breastfeeding in Hispanic women. Journal of immigrant minority health 17, 1192-1198 (2015).
Centers for Disease Control and Prevention (CDC). Coronavirus disease (COVID‐19) and breastfeeding. Vol. 2021 (2020).
Unicef East Asia and Pacific. Breastfeeding during the COVID-19 pandemic. Tips on keeping your baby healthy and safe. Vol. 2021 (Unicef, 2021).
Lubbe, W., Botha, E., Niela-Vilen, H. & Reimers, P. Breastfeeding during the COVID-19 pandemic–a literature review for clinical practice. International breastfeeding journal 15, 1-9 (2020).
Yusoff, M.S.B. ABC of content validation and content validity index calculation. Educational Resource 11, 49-54 (2019).
Yusoff, M.S.B. ABC of response process validation and face validity index calculation. Educational Resource 11(2019).
Linacre, J. Help for Winsteps Rasch Measurement and Rasch Analysis Software. Vol. 2021 (2018).
Davis, D.R. & Boone, W. Using Rasch analysis to evaluate the psychometric functioning of the other-directed, lighthearted, intellectual, and whimsical (OLIW) adult playfulness scale. International Journal of Educational Research Open 2, 100054 (2021).
Rao, C., Prasad, H.K., Sajitha, K., Permi, H. & Shetty, J. Item analysis of multiple choice questions: Assessing an assessment tool in medical students. International Journal of Educational Psychological Researches 2, 201 (2016).
Linacre, J. Dimensionality and Structural Validity investigation - an example. Vol. 2021 (2021).
Pallant, J., et al. Assessment of the dimensionality of the Wijma delivery expectancy/experience questionnaire using factor analysis and Rasch analysis. BMC pregnancy childbirth 16, 1-11 (2016).
Río, I., et al. Breastfeeding initiation in immigrant and non-immigrant women in Spain. European journal of clinical nutrition 65, 1345-1347 (2011).
González-Pascual, J.L., Ruiz-López, M., Saiz-Navarro, E.M. & Moreno-Preciado, M. Exploring barriers to breastfeeding among chinese mothers living in Madrid, Spain. Journal of immigrant minority health 19, 74-79 (2017).
Bai, Y.K., Lee, S. & Overgaard, K. Critical review of theory use in breastfeeding interventions. Journal of Human Lactation 35, 478-500 (2019).
Guo, J.-L., Wang, T., Liao, J. & Huang, C. Efficacy of the theory of planned behavior in predicting breastfeeding: Meta-analysis and structural equation modeling. Applied Nursing Research 29, 37-42 (2016).
Ismail, T.A.T., Muda, W.A.M.W. & Bakar, M.I. The extended Theory of Planned Behavior in explaining exclusive breastfeeding intention and behavior among women in Kelantan, Malaysia. Nutrition research and practice 10, 49-55 (2016).
Hamid, S.B.A., Yahya, N.J.J.o.C. & Sciences, H. Knowledge, attitude, prior exposure and intention to breastfeed among undergraduate university students. 3, 26-35 (2018).
Anselmi, P., Colledani, D. & Robusto, E.J.F.i.p. A comparison of classical and modern measures of internal consistency. 10, 2714 (2019).
Anselmi, P., Colledani, D. & Robusto, E. A comparison of classical and modern measures of internal consistency. Frontiers in psychology 10, 2714 (2019).
Stemler, S.E. & Naples, A. Rasch Measurement v. Item Response Theory: Knowing When to Cross the Line. Practical Assessment, Research, Evaluation 26, 11 (2021).