title: Determining a Cut-Off Point for Scores of the Breastfeeding Self-Efficacy Scale-Short Form: Secondary Data Analysis of an Intervention Study in Japan.
abstract: BACKGROUND
  Breastfeeding self-efficacy can be measured with the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Mothers with low BSES-SF scores stop exclusive breastfeeding prematurely, but specific interventions can prevent that undesirable outcome. Because those interventions can be expensive, often one must decide which mothers will receive them. For that purpose, a cut-off BSES-SF score would be useful, but none is available. Therefore, we aimed to assess the overall accuracy of BSES-SF scores as predictors of not practicing post-discharge exclusive breastfeeding, and to choose an appropriate cut-off score for making that prediction.
  
  
  METHODS
  This is a secondary data analysis of an intervention study. Data from 378 women in two non-Baby-Friendly Hospitals were analyzed. Participants were women in their third trimester who were 16 years of age or older, were able to read and write Japanese, were expected to have a singleton birth, and had completed the BSES-SF before discharge. BSES-SF scores were measured before discharge. Breastfeeding status was assessed 4 weeks and 12 weeks postpartum. Receiver Operating Characteristic (ROC) curves were used to assess the predictive ability of the BSES-SF and to inform the choice of a cut-off point.
  
  
  RESULTS
  For both of the ROC curves (4 and 12 weeks postpartum) the area under the curve was 0.74. To obtain a high sensitivity, a cut-off score of 50 was chosen. With that cut-off score the sensitivity was 79% and the specificity was 52% 4 weeks postpartum, and they were 77% and 52%, respectively, 12 weeks postpartum.
  
  
  CONCLUSIONS
  In conclusion, the BSES-SF has moderate overall accuracy to distinguish women who will not practice exclusive breastfeeding after discharge from those who will. At non-Baby-Friendly hospitals in Japan, interventions to support exclusive breastfeeding might be considered for new mothers who have BSES-SF scores that are less than or equal to 50.
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Nanishi
authors.affiliation: Office of International Academic Affairs, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Joseph
authors.initials: J
authors.lastname: Green
authors.affiliation: Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Taguri
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Masamine
authors.initials: M
authors.lastname: Jimba
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001942:Breast Feeding / Q000523:psychology*; D003627:Data Interpretation, Statistical; D005260:Female; D006761:Hospitals; D006801:Humans; D007564:Japan; D009035:Mothers; D049590:Postpartum Period; D011237:Predictive Value of Tests; D011594:Psychometrics / Q000592:standards*; D012372:ROC Curve; D015203:Reproducibility of Results; D020377:Self Efficacy; D011795:Surveys and Questionnaires / Q000592:standards*; D055815:Young Adult