Development of an assessment tool for the state of the breast during lactation: selection of items

Abstract

Purpose
ThisThis study aimed to develop an assessment tool to evaluate the state of the breast and milk secretion of lactating mothers. In this study, items were carefully selected for an assessment tool to increase its usefulness in a clinical setting.
Methods
The original study designed an assessment tool that was based on the results of previous study (Osada,2007). Since then the content and surface validity were discussed by researchers in the maternity and midwifery fields, as well as midwives specializing in breastfeeding support in the clinical field, resulting in new content being added to modify the original assessment tool to modified it. Five midwives, having different lengths of experience in breastfeeding support and 45 pairs of mother and child participated in the survey study. A total of 90 breasts from 45 lactating mothers, who had no history of breast disease were used as the subjects.
Results
Exploratory factor analysis was performed on the validity of construction concept using both the principal factor analysis with the Promax rotation method. From these methods, three factors and 16 items were extracted: specifically the factors were, 1) viewpoint for observation of milk production, 2) viewpoint for observation of galactostasis, and 3) viewpoint for observation of the way of children's sucking the breast in order. Among these factors, the second was closely correlated with that of the previous assessment tool. Since the results of diagnosis using the current tool were similar to those obtained using ultrasonography, its criteria-related validity was confirmed. Since Cronbach's α coefficient of reliability was 0.844 (0.872, 0.786, 0.852 for subordinate concepts), the reliability of this assessment tool was confirmed. The interclass correlation coefficient and Cohen's kappa (k) coefficient were less than 0.4 for some items in midwives with six or less years of breastfeeding support experience; but was coincident among midwives with eight or more years of similar experience. But, it was coincident among the midwives whose experience was 8 years or more.
Conclusion
This assessment tool for diagnosing the state of the breast during lactation was constructed with 3 factors and 16 items. The reliability and validity of the assessment tool were satisfactory. Items were chosen for the tool so as to lighten the load for its users and decrease the inter-item deviation. Therefore, it is expected that this assessment tool will be available in the clinical field.