Psychometric evaluation of the Chinese version of the exclusive breastfeeding social support scale: a cross-sectional study

Exclusive breastfeeding (EBF) contributes significantly to the physical and psychological health of both mothers and infants. Social support is a critical factor in maintaining EBF. However, there is a lack of validated instruments to assess the level of social support for EBF in China. To address this gap, this study aimed to translate the Exclusive Breastfeeding Social Support Scale (EBFSS) into Chinese and evaluate its reliability and validity.

The EBFSS was translated using the Brislin method and cross-culturally adapted. An expert panel review and a pre-survey were conducted to finalize the Chinese version. This cross-sectional study recruited 479 exclusively breastfeeding mothers between January and April 2025 through convenience sampling at four community hospitals in Hefei City. Validity was assessed using content validity, construct validity, convergent validity, discriminant validity, and criterion-related validity. Reliability was evaluated using Cronbach's α coefficient, McDonald's ω coefficient, split-half reliability, and test-retest reliability.

The Chinese version of the EBFSS consisted of 16 items across three dimensions: emotional, informational, and instrumental support. A total of 29 incomplete questionnaires were excluded, resulting in 450 valid responses for psychometric testing. The content validity of the items and scale levels ranged from 0.800 to 1.000 and 0.988, respectively; exploratory factor analysis (EFA) extracted three common factors with a cumulative variance contribution of 69.539%; confirmatory factor analysis (CFA) showed a good model fit (χ²/DF = 1.914, RMSEA = 0.064, CFI = 0.960, GFI = 0.907, TLI = 0.952, IFI = 0.960, TLI = 0.952). Correlation-related validity was 0.857 (p < 0.001). Cronbach's α coefficient was 0.931, McDonald's ω coefficient was 0.929, test-retest reliability was 0.936, and split-half reliability was 0.882.

The Chinese version of the EBFSS demonstrates good reliability and validity and can be used to assess social support among mothers who exclusively breastfeed. This tool provides a scientific foundation for future study and targeted interventions aimed at improving EBF outcomes in China.