Psychometric development and validation of the paternal breastfeeding support scale in Chinese mothers: a methodological cross-sectional study

TL;DR

This study developed and validated a 22-item scale to measure paternal support for breastfeeding among Chinese mothers, showing strong reliability and cultural relevance.

Contribution

The PBSS-22 is a culturally adapted, psychometrically validated tool for assessing paternal breastfeeding support in China.

Findings

The PBSS-22 has a four-factor structure explaining 66.5% of total variance.

The scale showed excellent internal consistency (Cronbach’s α = 0.935) and strong content validity.

The tool is suitable for identifying support deficiencies and guiding family-centered interventions.

Abstract

Paternal support significantly influences breastfeeding success; however, culturally appropriate measurement tools are limited in China. This study aimed to develop and validate the Paternal Breastfeeding Support Scale (PBSS-22) through the systematic cross-cultural adaptation of the Hughes Breastfeeding Support Scale for Chinese healthcare contexts.

A cross-sectional psychometric validation study was conducted at a tertiary hospital in Hangzhou, China, between October 2018 and October 2019. The Hughes Breastfeeding Support Scale underwent cross-cultural adaptation, including forward-backward translation, expert review (n = 6), and cognitive interviews (n = 30). Postpartum women at 42 days post-delivery were recruited through convenience sampling. Psychometric evaluation comprised four complementary analytical approaches: (1) comprehensive eight-method item analysis encompassing response distribution evaluation, independent-samples t-tests for discrimination, Spearman and Pearson correlation analyses, and internal consistency diagnostics; (2) exploratory factor analysis using principal component extraction with promax rotation, preceded by Kaiser-Meyer-Olkin and Bartlett’s test verification of data suitability; (3) content validity assessment through Item-level Content Validity Index (I-CVI), Scale-level Content Validity Index for Universal Agreement (S-CVI/UA), and Scale-level Content Validity Index for Average Agreement (S-CVI/Ave); and (4) reliability estimation using Cronbach’s α and Spearman–Brown split-half reliability coefficients. All analyses were performed using SPSS 20.0, with statistical significance set at p < 0.05.

Of the 300 recruited participants, 229 provided valid responses (76.3% response rate). Participants had a mean age of 30.97 ± 4.27 years, with 67.7% practicing exclusive breastfeeding. Following systematic item analysis and factor extraction, the final 22-item scale demonstrated a four-factor structure: Emotional Support (8 items, factor loadings 0.687–0.938), Informational Support (4 items, 0.610–0.862), Practical Assistance (6 items, 0.547–0.857), and Childcare Support (4 items, 0.468–0.964). The four factors explained 66.5% of the total variance. Content validity indices showed strong expert consensus (S-CVI/Ave = 0.946, I-CVI range 0.70–1.00). Internal consistency was excellent (Cronbach’s α = 0.935 overall, 0.803–0.927 for subscales), with a split-half reliability of 0.857.

The PBSS-22 demonstrates robust psychometric properties and cultural appropriateness for measuring multidimensional paternal breastfeeding support in the Chinese population. This validated instrument enables the targeted assessment of support deficiencies and the development of evidence-based, family centered interventions to enhance breastfeeding outcomes.

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