Objective: The purpose of this study is to contribute to the reliability and validity of Mulford’s Maternal-Baby Assessment (MBA) instrument by correlating it to LATCH and Maternal Breastfeeding Evaluation Scale (MBFES) scores.
Design: Criterion-related correlational study to establish validity and reliability.
Population, Sample, Setting, Years: Thirty term mother-infant dyads who report breastfeeding difficulties within 12 hours of delivery will complete three to four breast feedings in the kangaroo care position prior to discharge. Mother-infant dyads are patients in a tertiary level University in the Midwest. Data collection is in progress and will be completed by May 2002.
Intervention and Outcome Variables: All mothers place the infant in the kangaroo care position (the diaper-clad infant is placed skin-to-skin on the mother’s chest 30-60 minutes before anticipated feedings and covered across the infant’s back with mother’s clothing and a blanket). Breastfeeding occurs during skin-to-skin placement. Feedings occur every three to four hours with 2-3 feedings being observed on postpartum day one and one feeding on postpartum day two yielding 90 to 120 feedings as the data set.
Methods: Instruments: Maternal and infant’s progress in learning how to breastfeed will be measured with the Maternal-Baby Assessment instrument. The MBA scores five sequential steps in the breastfeeding process: signaling, positioning, fixing, hormonal response/milk transfer, and ending. Each partner in the nursing couple receives a 1 for any or all demonstrated behaviors or 0 if no behaviors are observed for each of the five steps. Since the MBA elements occur sequentially from before the feeding encounter to after it is over, both partners must complete each step before either partner gets a point on the next step. Mothers and infants are scored for their best performance during the entire course of a nursing session. The LATCH was developed as a systematic assessment of the breastfeeding couple. Five key components of the breastfeeding process are evaluated. Each component is score zero, one or two based on observation of specific behaviors for a possible total of 10. The components are not sequential. Extensive satisfactory psychometric data is available for this instrument. The MBFES evaluates maternal perception of breastfeeding success and satisfaction. This instrument is designed to measure mother’s overall satisfaction with the breastfeeding experience giving consideration to both positive and negative maternal and infant factors. The 30 item 5-point Likert scale yields a total possible score of 150; higher scores indicating greater satisfaction with breastfeeding. The three subscales - maternal enjoyment/role attainment (14 items), infant satisfaction/growth (8 items), and lifestyle/maternal body image (8 items)- delineate subtle yet salient dimensions of the mother’s and infant’s breastfeeding experiences that occur because breastfeeding is a complex process involving the emotional and psychological responses of two attached, yet separate, individuals. Reliability: Reliability of the MBA will be assessed by three different procedures. First, test-retest reliability will be established by doing a second scoring of the breastfeeding experience within 2-3 minutes after each feeding to accommodate the anticipated rate of change in scoring ability. Second, the MBA will be correlated to the LATCH by Spearman rank correlation coefficients among instruments’ scores. The MBA will be correlated to the MBFES using a point-biserial correlation coefficient. Accepted value on all correlations will be .7 or higher. Validity: The upper limit of validity will be established by the correlation coefficient between the MBA and the LATCH since reliability sets the upper limit on validity. Validity will also be established by percent agreement between the tools as scored by one observer. MBA and LATCH appear to be similar in all dimensions except one. The LATCH scores erectness of the nipple and the MBA does not, suggesting that the correlation between these 2 instruments should at least be moderate. The LATCH and MBFES correlate very highly for satisfaction. Thus, by inductive reasoning, correlations between MBA and MBFES are recommended.
Findings: Beginning estimates of reliability and validity will be formulated. Refined techniques for validity may be indicated.
Conclusions & Implications: Having a reliable and valid tool to assess breastfeeding progress will allow nurse researchers to evaluate interventions designed to enhance and encourage breastfeeding. Such a tool is also important for staff nurses and lactation consultants so they have a convenient, easy way to assess the maternal-infant dyad while feeding and to guide interventions as necessary.
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