Abstract
Objectives
To develop an Assessment Tool that identifies Lactational Mastitis (ATLM) for lactating mothers and to examine its reliability and validity.
Methods
The original "ATLM" was developed based on a descriptive study and a comprehensive review of the literature. After receiving examination on the content validity by the experts who are supporting lactating mothers, we made a preliminary study of ATLM. Based on the results, the present study was conducted, with 16 examination items. The subjects, from whom the lactating mothers with the previous history of breast disease except mastitis were excluded, were 277 pairs of mothers and child, with 554 breasts, during the III stage of lactation. The survey was conducted at 4 institutions in total such as the lactation and child-care center, etc. from April to November, 2010. The survey consisted of filling in the questionnaire for the mothers and children who visited to the survey-cooperating institutions, and measuring their body temperatures. The midwives were asked to fill in the ATLM and LATCH which are being developed. Additionally, 1 week after the survey, the mothers were asked to reply to another questionnaire inquiring of their conditions.
Results
Exploratory factor analysis by principal factor analysis with promax rotation was conducted. The following three factors comprised of 12 items were finally extracted: (1) "Status of milk, (2)" "Production of milk," and "(3) Drainage of milk." A confirmatory factor analysis was conducted by analyzing covariance structures and the hypothesized statistical model was found to fit the actual data. The reliability of the scale was confirmed by a Cronbach alpha's internal consistency reliability coefficient of 0.820 (0.803-0.859 for subscales) and an inter-rater reliability coefficient of 0.490-0.852. The criterion-related validity was confirmed by concurrent validity. The coefficient was r=-0.525** and predictive validity was confirmed with a predictive value of 96.9%. The cut-off point for referral to a physician was 32 points. The sensitivity at this point was 98.0% and the specificity was 87.5%. In addition, the 1st factor scored 11 points higher than the 2nd factor.
Conclusion
The above findings indicate that the "ATLM" is sufficiently valid to improve the quality of identifying lactational mastitis.
