Development and Assessment of a Questionnaire to Study Protection, Promotion, and Support of Breastfeeding

Abstract Objective To develop an instrument to measure variables that influence health care professionalsu0027 behavior with regard to the protection, promotion, and support of breastfeeding, especially one that related to the Baby-Friendly Hospital Initiative (BFHI), and to conduct a psychometric assessment. Design Cross-sectional study. Setting Two public health departments in eastern Spain. Participants A convenience sample of 201 maternity and primary care professionals. Methods The Questionnaire of Professional Breastfeeding Support of the Healthcare Quality Management Program of the Spanish Region of Murcia (QPBS-EMCA) was developed using the theory of reasoned action as a conceptual framework and the Global Criteria for evaluating implementation of the BFHI. It comprises 4 scales on beliefs, attitudes, subjective norms, and behavioral intention. The development process included item assessment and selection based on expert judgment and statistical criteria. The QPBS-EMCA scales were assessed for reliability and validity, including internal consistency, principal components factor analysis, criterion-related validity, and comparison of contrasted groups. Results The Beliefs, Attitudes, and Subjective Norms Scales were multidimensional, whereas the Behavioral Intention Scale was unidimensional. Cronbachu0027s alpha coefficients ranged from .65 to .81. Total scores for the Beliefs, Attitudes, and Subjective Norms Scales predicted scores for the Behavioral Intention Scale. Scores for the different QPBS-EMCA scales were related to professionalsu0027 previous breastfeeding training, interest in new training, and appraisal of breastfeeding policy in the workplace. Conclusion The psychometric characteristics of the QPBS-EMCA render it suitable for evaluation of professionalsu0027 beliefs, attitudes, subjective norms, and behavioral intention in relation to breastfeeding and could be useful in health care facilities implementing quality improvement processes based on the BFHI.