Development and psychometric evaluation of the Mothers' breastfeeding empowerment scale: A mixed methods study

Background: Assessment of mothers' breastfeeding empowerment (BE) needs valid and reliable instruments. Objectives: The aim of this study was to develop and psychometrically evaluate the Mothers' BE Scale (MBES). Methods: This mixed methods study was conducted in 2018 in Isfahan, Iran. Initially, a literature review and a qualitative study were conducted and their results were used to develop MBES. The qualitative study was conducted through 33 semi-structured interviews with 33 participants and two group discussions with six participants and the data were analyzed through Hsieh and Shannon's conventional content analysis method. Then, the face, content, and construct validity and reliability of the scale were evaluated. Construct validity was evaluated through the exploratory factor analysis of the data obtained from 160 breastfeeding mothers. Results: The primary MBES had 47 items. Forty-one items had acceptable content validity ratio (i.e. more than 0.56) and content validity index (i.e. more than 0.70). In construct validity evaluation, four items were omitted and the remaining 37 items were loaded on six factors which explained 53.67% of the total variance. Using the data obtained from 160 mothers, Cronbach's alpha of the scale was 0.87. Conclusion: The 37-item MBES is a valid and reliable instrument and can be used to assess mothers' BE and develop need-based interventions for BE and breastfeeding promotion.