The German version of the Bristol breastfeeding assessment tool: A validation study

This study aimed, first, to validate the Bristol Still [Breastfeeding] Assessment Tool (BSAT) through determining inter-rater reliability, construct and criterion and second, to assess if healthcare professionals viewed the tool as appropriate for use on a maternity ward.

A validation study was performed at the maternity ward of a university hospital in the German-speaking region of Switzerland.

We included 44 mother-newborns dyads in the validation study, and 15 healthcare professionals assessed its appropriateness for use on a maternity ward.

Inter-rater reliability was determined by observing 82 breastfeeding sessions, which were independently assessed by two assessors based on the criteria of the BSAT. Convergent validity was determined using the Breastfeeding Self-Efficacy Scale Short Form. Predictive validity was determined by breastfeeding status at hospital discharge. A self-developed 5-item questionnaire assessed the appropriateness of the tool for use on a maternity ward. Inter-rater reliability was good at the item level (six out of eight intraclass-correlation coefficient values were greater than 0.75 and p < 0.00). The convergent validity demonstrated a moderate positive correlation with breastfeeding self-efficacy, with a Pearson's correlation coefficient of 0.69 (Confidence Interval = 0.46-0.83, p < 0.00). The predictive validity with breastfeeding status at hospital discharge was not statistically significant with χ2(22, n = 44) = 26.98, p = 0.21). Healthcare professionals confirmed that the tool was appropriate for using in daily practice on the maternity ward.

The BSAT had an overall good inter-rater reliability and a moderate construct validity with the mother's breastfeeding self-efficacy level and has comparable psychometrics properties as the original.

We recommend assessing breastfeeding with the BSAT and scoring it at the item level and not with a total score. Using the BSAT on maternity wards could help monitor and objectify breastfeeding practices.