The Beliefs About Breastfeeding Questionnaire (BAB-Q): A psychometric validation study

Questionnaires used to assess women's beliefs as a predictor of breastfeeding behaviour are not theoretically informed or tested for psychometric validity and reliability. This study conducted a psychometric evaluation of the Beliefs About Breastfeeding Questionnaire (BAB-Q).

A two-phase evaluation in an online cross-sectional questionnaire study (N = 278) and cohort study sample (N = 264). A ten-item questionnaire was proposed to assess women's beliefs about the benefits and efforts of breastfeeding.

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) assessed construct validity and reliability. Multivariate regression analyses assessed validity in predicting breastfeeding behaviour and experiences.

EFA found a shortened 8-item, 2-factor model had good fit (χ²  = 23.3, df = 13, p < .040; CFI = .99, TLI = .99, RMSEA = .05), with significant factor loadings. Factor 1 (benefit beliefs) and factor 2 (effort beliefs) accounted for 47 and 19.4% of the explained variance and correlated moderately (r = -.40). CFA confirmed the solution in the cohort sample (χ²  = 49.6 df = 19, p < .010; CFI = .97, TLI = .96, and RMSEA = .078). Adjusted regression analyses found beliefs did not reliably predict infant feeding practices. Women's beliefs significantly predicted the likelihood that women experienced breastfeeding as 'much more' positive and negative than they expected.

The eight-item questionnaire showed good model fit with acceptable loadings, and good reliability for all subscales. The utility of the BAB-Q at predicting breastfeeding behaviour remains unclear and unsupported by empirical evidence. Further assessments of the predictive validity of the questionnaire in longitudinal studies with diverse beliefs and infant feeding practices are required.