title: A Critical Review of Instruments Measuring Breastfeeding Attitudes, Knowledge, and Social Support.
abstract: BACKGROUND
  Breastfeeding provides beneficial health outcomes for infants and their mothers, and increasing its practice is a national priority in many countries. Despite increasing support to exclusively breastfeed, the prevalence at 6 months remains low. Breastfeeding behavior is influenced by a myriad of determinants, including breastfeeding attitudes, knowledge, and social support. Effective measurement of these determinants is critical to provide optimal support for women throughout the breastfeeding period. However, there are a multitude of available instruments measuring these constructs, which makes identification of an appropriate instrument challenging. Research aim: Our aim was to identify and critically examine the existing instruments measuring breastfeeding attitudes, knowledge, and social support.
  
  
  METHODS
  A total of 16 instruments was identified. Each instrument's purpose, theoretical underpinnings, and validity were analyzed.
  
  
  RESULTS
  An overview, validation and adaptation for use in other settings was assessed for each instrument. Depth of reporting and validation testing differed greatly between instruments.
  
  
  CONCLUSIONS
  Content, construct, and predictive validity were present for most but not all scales. When selecting and adapting instruments, attention should be paid to domains within the scale, number of items, and adaptation.
authors.affiliation: 1 Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA.
authors.forename: Corrine S
authors.initials: CS
authors.lastname: Casal
authors.affiliation: 1 Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Lei
authors.affiliation: 1 Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA.|2 Department of Anthropology, Northwestern University, Evanston, IL, USA.
authors.forename: Sera L
authors.initials: SL
authors.lastname: Young
authors.affiliation: 3 School of Nursing, University of California, San Francisco, CA, USA.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Tuthill
mesh_terms: D001942:Breast Feeding / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011594:Psychometrics / Q000295:instrumentation* / Q000379:methods; D015203:Reproducibility of Results; D012944:Social Support; D014894:Weights and Measures
keywords: attitudes; breastfeeding; human milk; instruments; knowledge; psychometric analysis; review; social support