Evaluation of the breast‐feeding limitation scale as a useful tool for prediction of continuing breast‐feeding

Purpose : The purpose of this study was to develop a questionnaire for gathering information about the factors restricting the continuation of breast-feeding at the time of discharge from the maternity hospital after childbirth. As a first step, a statistical analysis was conducted regarding the predictability at the time of hospital discharge of the breast-feeding limitation factors which were collected during a survey at the health checkup１month after childbirth.
Methods : The information regarding the factors limiting breast-feeding, gathered from mothers who could not continue breast-feeding at one month after childbirth, was analyzed using the dependent-care model proposed by Orem, a nursing theoretician. Based on the analysis results, a questionnaire consisting of ３６ items ４ point Likert-type scale was prepared. This draft questionnaire was pre-tested, and finally a questionnaire consisting of ３０ items（▯ coefficient＝０．８１）was prepared.
Using the re-testing method, an examination was undertaken to see the extent to which the limitation factors gleaned through the questionnaire survey can be predicted at the time of hospital discharge. The subjects were ７０ mothers who had experienced rooming-in upon normal delivery. The survey was conducted twice : at the time of hospital discharge and at the time of the health checkup１month after delivery.
Results：１．Regarding the prepared questionnaire, the correlation between items was determined through the re-test method, according to which the subjects were surveyed at the time of hospital discharge and at the time of the health checkup １ month after delivery. As a result, an extremely strong correlation, that is，０．９ or upward, was observed in １ item of the questionnaire survey, a strong correlation, that is，０．７ or upward, was observed in ５ items, and no correlation was observed in ８ items.
２．The constructive concept of the questionnaire survey at the time of hospital discharge was analyzed based on the ２２ for which there was a strong or extremely strong correlation ; the other８items for which no correlation was observed were left out. After ３ varimax rotations, a model with １３ items and ４ factors was verified. Cronbach's ▯ coefficient for the entire questionnaire was ０．８１，and that for the subscale ranged from ０．５８ to ０．８３．
３．The correlation between the questionnaire scores at the time of hospital discharge and at the time of the health checkup １ month after delivery was ０．６５（p＜０．０００１）for the entire questionnaire, while that for the subscale ranged from ０．３７（p＝０．００１５） to ０．７６（p＜０．０００１）．
４．The mean score of the breast-feeding group and that of the mixed-feeding group at the time of the health checkup １ month after delivery were ２７．３±７．０ and ３１．７±６．８，respectively ; that is, a significant difference（p＜０．０５）was observed between the two groups. It has been found that the mixed-feeding group has more factors limiting breast-feeding in comparison with the breast-feeding group, and it has been suggested that the information gathered by the questionnaire can indeed constitute a firm basis for predicting difficulties in continuing breast-feeding.
Conclusion : Some of the limitation factors discovered at the time of the health checkup １ month after delivery could be predicted at the time of hospital discharge ; thus, it has been suggested that those limitation factors can be included in a questionnaire survey on factors limiting breast-feeding. The questionnaire to be filled out at the time of hospital discharge after childbirth will be prepared upon further review of its reliability and validity. We expect that the questionnaire will constitute a firm basis for predicting the presence of factors limiting breast-feeding already at the time of hospital discharge, will help staff evaluate the feasibility of self-care, which is said to be necessary for puerperal women, and will help staff elucidate the necessity of nursing-care intervention.