Development and validation of the breastfeeding resilience scale (BRS) among employed mothers after returning to work

The increasing number of employed mothers in the workforce is an inevitable trend in China. Employed mothers may stop breastfeeding due to work-related stressors. However, many mothers overcome these challenges and continue breastfeeding after returning to work. This study aimed to develop and validate a tool to understand employed mothers' experiences with continuing breastfeeding after returning to work, based on Kumpfer's Resilience Framework, in China.

The study comprised three phases. Phase 1 involved item pool generation through a literature review, focus groups, and a Delphi survey, followed by pre-testing with 15 mothers to finalize the breastfeeding resilience scale (BRS) trial version. In Phase 2, the trial BRS was administered in a cross-sectional survey of employed mothers from 18 provincial-level regions of China who were recruited using purposive sampling, and valid responses from 172 participants were included in item analysis and exploratory factor analysis (EFA) to develop the provisional BRS. In Phase 3, the provisional BRS and the Connor-Davidson Resilience Scale (CD-RISC) were administered in a cross-sectional survey of employed mothers from 23 provincial-level regions of China who had returned to work, using purposive sampling. Valid responses from 200 participants were included to evaluate reliability and validity and develop the formal BRS. Reliability was examined using internal consistency and split-half coefficients. Validity was assessed through content, construct, convergent, discriminant, and criterion-related validity analyses.

The formal BRS contains 24 items across five dimensions. Cronbach's α was 0.897 (95% CI: 0.875-0.916) for the overall scale, and Cronbach's α coefficients for the five dimensions ranged from 0.750 (95% CI: 0.683-0.805) to 0.875 (95% CI: 0.847-0.900). Split-half reliability was 0.787. EFA yielded five factors explaining 63.139% of the variance, with all item loadings exceeding 0.50. Confirmatory factor analysis (CFA) showed that most fit indices met the recommended criteria, with χ²/df = 1.654, RMSEA = 0.057, CFI = 0.923, IFI = 0.924, TLI = 0.912, although GFI = 0.860 and NFI = 0.828 were below the 0.90 cutoff. Average variance extracted (AVE) values ranged from 0.441 to 0.570, with the social dimension having an AVE of 0.441, and composite reliability (CR) values ranged from 0.755 to 0.876. Correlation coefficients among the dimensions were below 0.50, and the square roots of the AVE values for each dimension ranged from 0.663 to 0.755. Correlations between BRS dimensions and the total score on the CD-RISC criterion scale ranged from 0.410 to 0.629, all statistically significant.

This study developed and validated a Breastfeeding Resilience Scale for employed mothers after returning to work. It may provide healthcare workers engaged in breastfeeding promotion with an assessment tool to identify employed mothers' intrinsic motivation and psychological resilience throughout their breastfeeding journey.

Not applicable.