Measuring Maternal Self-Efficacy in Breastfeeding: Umbrella Review and an Evidence-Based Framework

Human milk is the gold standard for newborn nutrition. Maternal self-efficacy has emerged as an essential determinant of breastfeeding success. However, the proliferation of assessment instruments over recent decades has produced a fragmented evidence base, underscoring the need for an overarching synthesis to clarify their validity and clinical utility.

To identify, describe, and critically appraise instruments assessing maternal breastfeeding self-efficacy and to develop an evidence-based framework for midwifery practice.

An umbrella review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology from August to October 2025. Systematic searches were performed in MEDLINE, CINAHL, EMBASE, and the Cochrane Database of Systematic Reviews. Two reviewers independently assessed methodological quality and risk of bias using the JBI Critical Appraisal Checklist and the ROBIS tool. Data extraction focused on review characteristics and psychometric properties, using a standardized template to ensure consistency. The protocol for this umbrella review was prospectively registered in PROSPERO (CRD420251124383).

Seven reviews were included-five systematic reviews, one scoping review, and one narrative review-identifying eight measurement instruments. The Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF) and the Prenatal Breastfeeding Self-Efficacy Scale (PBSES) demonstrated the strongest psychometric evidence and were assigned Grade A recommendations.

Findings confirm the theoretical relevance of Bandura's self-efficacy construct in breastfeeding and highlight the need for concise, valid, and culturally adaptable instruments. A two-stage screening strategy, PBSES during pregnancy and BSES-SF postpartum, is recommended to guide tailored interventions.