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A comparative analysis of three psychological challenge assessment tools for predicting breastfeeding outcome at six
Xiaoke Jiang1, Weiwei Liang2, Yiwen Liang2
1General Intensive Care Unit, Guangdong Provincial Maternity and Child Health Care Hospital, Guangzhou, China; School of Nursing, Guangzhou Medical University, Guangzhou, China.
Problem:
Psychological challenges experienced by mothers are strongly associated with breastfeeding cessation within six months after childbirth.
Background:
The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), Maternal Breastfeeding Evaluation Scale (MBFES), and Existential Breastfeeding Scale (ExBreastS) assess distinct psychological aspects of breastfeeding challenges. Their predictive value for 6-month outcomes in Chinese mothers is underexplored.
Aim:
To evaluate and compare the predictive performance of the BSES-SF, MBFES, and ExBreastS for breastfeeding outcomes at six months postpartum.
Methods:
From June to September 2024, postpartum mothers (≤3 months) were recruited via convenience sampling. Participants completed the BSES-SF, MBFES, and ExBreastS, with breastfeeding outcomes assessed via telephone follow-up at six months. Predictive performance was evaluated using receiver operating characteristic (ROC) curves, area under the curve (AUC), sensitivity, specificity, Youden index, positive predictive value (PPV), negative predictive value (NPV), DeLong test, calibration curves, and decision curve analysis (DCA).
Findings:
The DeLong test indicated that BSES-SF had a higher AUC for predicting breastfeeding at six months, whereas ExBreastS had a higher AUC for predicting exclusive breastfeeding. Calibration curves showed that BSES-SF and MBFES were closer to the ideal line when predicting any breastfeeding. ExBreastS provided greater clinical net benefit for predicting exclusive breastfeeding.
Discussion And Conclusion:
BSES-SF demonstrated superior performance for identifying mothers at risk of breastfeeding cessation, while ExBreastS was more effective for predicting exclusive breastfeeding. BSES-SF and MBFES offered higher accuracy for predicting any breastfeeding, whereas ExBreastS provided greater clinical utility for exclusive breastfeeding.
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