Development and measurement properties of the Chinese breastfeeding self-regulation questionnaire

Background: although new mothers are aware of the benefits of breastfeeding, many of them stop breastfeeding early in the postpartum period. Maternal psychosocial factors have been shown to contribute to early breastfeeding cessation. According to Self-Determination Theory (SDT) maternal self-determination is an indispensable factor in studying motivation to breastfeed. There are no validated instruments to assess maternal breastfeeding motivation and self-determination. Objective: our aim was to develop and assess the psychometric properties of the Breastfeeding Self-Regulation Questionnaire (BSRQ) for Chinese pregnant women in Hong Kong. Method: we reviewed the literature and devised items for a preliminary version of the questionnaire. Thirty-five context-specific items in English were generated. We translated the items into Chinese and then back translated them into English following established translation procedures. We employed exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to assess the structure of the questionnaire. Predictive validity was measured by assessing the relationship between the BRSQ score and actual duration of breastfeeding. Findings: we recruited 591 participants from three publicly funded antenatal clinics. Of the 35 items in the preliminary BSRQ, 22 were retained by EFA. CFA revealed that there were 5 factors including intrinsic, identified, integrated, introjected and external regulation. The goodness of fit of the CFA model was adequate. The Cronbach's alpha of the BSRQ was 0.86. For every one point increase in the BSRQ score, participants had 15% higher odds of any breastfeeding (OR = 1.15, 95% CI 1.07-1.23) and 9% higher odds of exclusive breastfeeding (OR = 1.09, 95% CI 1.02-1.17) at 6 weeks postpartum. Conclusion: the Chinese version of the BSRQ was a valid and reliable tool to measure maternal self-determination towards breastfeeding.