NDLI: Development and validation of a novel self-assessment tool for breastfeeding mothers

Content Provider	Springer Nature : BioMed Central
Author	Ong, Chengsi Loy, See Ling Pang, Cynthia Lee, Sharon Krishnan, Shamini Tan, Jin Ting Chan, Daniel Ku, Chee Wai Chan, Jerry Kok Yen Yap, Fabian Chua, Mei Chien
Abstract	Background Difficulties with breastfeeding can lead to early breastfeeding cessation. Empowering mothers through self-assessment and education of breastfeeding skills can help support them. We aimed to develop and validate a tool for self-screening and education on breastfeeding skills. Methods A six-item tool was developed through literature review and expert interviews, covering domains of breastfeeding position, nipple shape, breast engorgement, infant latch, swallowing and intake. Eight experts assessed the tool’s relevance, clarity, simplicity and ambiguity. Scores were used to determine item-level content validity index (I-CVI) and scale-level content validity index (S-CVI). Items with values ≤ 0.83 (best possible score = 1.00) were revised. Following revision, a convenience sample of breastfeeding mothers were recruited from maternity wards and clinics to determine the tool’s internal consistency, face, criterion and construct validity. Participants and lactation consultants (LC) independently completed the tool based on the same breastfeeding episode. Internal consistency was determined by Cronbach’s alpha. Criterion validity was assessed by comparing participant and LC scores using Bland-Altman plots. Construct validity was determined by comparing scores in participants who were and were not referred to a LC. Receiver operating characteristic (ROC) curve was used to determine a cut-off score for LC referral by optimizing sensitivity and specificity. Results The tool demonstrated acceptable content validity, with I-CVI and S-CVI values for relevance, clarity, simplicity and ambiguity above the threshold, except for S-CVI of simplicity and ambiguity, and the tool was revised accordingly. Most mothers who completed the tool (n = 58) found it easy to understand (87.9%), relevant (91.4%) and useful (86.2%). Cronbach’s alpha was 0.66, which improved to 0.74 with the removal of the item on “engorgement”. With the remaining five items, ROC analysis showed an area under the curve of 0.79 [(95%CI 0.67–0.90), p < 0.001], with a score of ≤ 6 indicative of an LC referral (sensitivity = 86%, specificity = 55%). Bland-Altman plots showed acceptable agreement between participant and LC scores with a mean difference of 0.22 (95%CI -3.02–3.47). Conclusions We developed and validated a simple five-item tool for mothers to assess and be educated about breastfeeding skills. Further study on the tool’s predictive validity and effectiveness within a clinical pathway is warranted.
Related Links	https://internationalbreastfeedingjournal.biomedcentral.com/counter/pdf/10.1186/s13006-025-00715-7.pdf
Ending Page	9
Page Count	9
Starting Page	1
File Format	HTM / HTML
ISSN	17464358
DOI	10.1186/s13006-025-00715-7
Journal	International Breastfeeding Journal
Issue Number	1
Volume Number	20
Language	English
Publisher	BioMed Central
Publisher Date	2025-04-03
Access Restriction	Open
Subject Keyword	Maternal and Child Health Breastfeeding Breastfeeding assessment Validity Screening tool
Content Type	Text
Resource Type	Article
Subject	Obstetrics and Gynecology Pediatrics, Perinatology and Child Health
Journal Impact Factor	2.9/2023
5-Year Journal Impact Factor	3.6/2023

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

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