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Systematic Review (Pages: 8821-8829)

A Systematic Review of Instruments Measuring Family and

Social Support of Breastfeeding Mothers
Masaudeh Babakhanian1 , Soraya Sayar2, Faezeh Sadat Akrami 3, *Masumeh
Ghazanfarpour4, Leila Kargarfard5, Fatemeh Rajab Dizavandi 6, Talat Khadivzadeh61
1
Ph.D student of Behavioral Sciences, Social determinants of Health Research Center, Semnan University of
Medical Sciences, Semnan, Iran. 2Ph.D of Sociology, Department of Social Sciences, Islamic Azad University,
Tehran North Branch, Tehran, Iran. 3Department of Clinical Psychology, School of Humanities and Social
sciences, Islamic Azad University, Science and Research Branch, Tehran, Iran. 4Department of Midwifery, Razi
School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran. 5 Instructor of
Fatemeh School Nursing and Midwifery, Shiraz University of Medical Sciences, Iran. 6 Evidence-Based Care
Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract
Background: Due to the low rate of breastfeeding among working mothers and support of
interventions to increase the duration of breastfeeding, this systematic review conducted to evaluate
psychometric properties of instruments measured mother’s perception of Breastfeeding Support.
Materials and Methods: The search was carried in English language databases including Medline (via
PubMed), Scopus, Cochran library and Web of Science since inception to March 2018 regarding
published studies evaluating the psychometric properties of the Breastfeeding Self-Efficacy. The
COSMIN checklist was used to assess the quality of related studies.
Results
Authors of Perceived Breastfeeding Support Assessment Tool’ (PBSAT) suggested that instrument
seem to should be two factors "workplace environmental support for breast-feeding working mother"
and "the available social environmental support for working mothers". Total Cronbach's alpha was
0.85. In exclusive breastfeeding social support (EBFSS) instrument, based on exploratory factor
analysis, 16 items grouped into three factors "instrumental", "emotional" and "informational factors"
accounted 66% of total variance. EFA were followed by confirmatory factors analysis showed
Modified model was partially fitted to the data. In the Workplace Breastfeeding Support Scale
(WBSS), EFA identified four dimensions of breastfeeding support at workplace. These four factors
labeled "technical support", "breastfeeding-friendly environment", "facility support" and "peer
support". Cronbach’s alpha was 0.77 and split-half reliability was r=0.86. In Employee Perceptions of
Breastfeeding Support Questionnaire (EPBS-Q), data scaled by the Multidimensional Random
Coefficients Multinomial Logit Model. A two-dimensional model (company polices/work culture and
manager and her co-workers) were emerged. Cronbach’s alpha was excellent (almost 0.90).
Conclusion: Four instruments found to assess breastfeeding was valid and reliable to measure breast
feeding in social and workplaces.
Key Words: Adolescents, Aggression, Children, Life Satisfaction, Self-rated Health.
*Please cite this article as: Masaudeh Babakhanian, Soraya Sayar, Faezeh Sadat Akrami, Masumeh
Ghazanfarpour, Leila Kargarfard, Fatemeh Rajab Dizavandi, et al. A Systematic Review of Instruments to
Measure Mothers' Perception of Breastfeeding Family and Social Support. Int J Pediatr 2019; 7(1): 8821-29.
DOI: 10.22038/ijp.2018.33521.2959

*Corresponding Author:
Masumeh Ghazanfarpour, Department of Midwifery, Razi School of Nursing and Midwifery, Kerman
University of Medical Sciences, Kerman, Iran.
Email: [email protected]
Received date: Mar.27, 2018; Accepted date: Aug.22, 2018

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Psychometric Properties of Breastfeeding Support of Mothers

1- INTRODUCTION support breastfeeding interventions, it is

Breast milk as the most appropriate required to present a tool with suitable
psychometric to health providers. Review
nutrition for newborns is the most
literature identified four instruments to
important and effective action to support
the infant health. Therefore, it is highly assess breastfeeding. Hirani et al. in
Pakistan developed a 29-item tool named
recommend to exclusive breastfeeding (1-
Perceived Breastfeeding Support
5). According to the World Health
Organization (WHO), and the United Assessment Tool (PBSAT) (15). The
second instrument developed by Boateng
Nations Children's Fund (UNICEF), each
et al. in Uganda, exclusive breastfeeding
child needs exclusive breastfeeding up to
six months and continued by two years of social support (EBFSS) is a 16-item tool
(16). In the third study, BAI et al. (17) in
old or more (1). The breast milk nutrition
America designed and developed a 12-
play important role in decreasing infant
mortality, increasing in intelligence item instrument labeled the Workplace
Breastfeeding Support Scale [WBSS].
quotient, and also it provided the best
Green et al. in America designed and
pattern of infant growth and development
and their health in adulthood (6-8). developed a 54-item instrument labeled
Employee Perceptions of Breastfeeding
Given the global goals of nutritional Support Questionnaire (EPBS-Q) (18).
policies in elevating the level of exclusive Due to the low rate of breastfeeding in
breastfeeding and the promotion of some countries especially among working
breastfeeding programs, one of the ways mothers and support of interventions to
can be to concentration on the increase the duration of breastfeeding, this
breastfeeding-influencing factors (9) such systematic review conducted to evaluate
as knowledge of mothers towards the psychometric properties of instruments
advantages of breastfeeding, supportive measured mother’s Perceived
systems, socioeconomic class and Breastfeeding Support to give
breastfeeding self-efficacy. Factors like comprehensive information for health
socioeconomic status are less varied and provider and researches to use in theirs
the healthcare providers for improving the clinics and research.
outcome need to consider variable
parameters such as maternal knowledge of 2- MATERIALS AND METHODS
the advantages of breastfeeding,
2-1 search strategy
breastfeeding self-efficacy (10-13), and
breastfeeding supportive systems such as The search was independently done
access to health care providers in the event by two authors in English language
of problems with breastfeeding, support databases including Medline (via
and encouragement from family and health PubMed), Scopus, Cochran library and
care workers. Since health care providers Web of Science since their inception to
are not always available, experienced present (March 2018) regarding published
women are successful in forming support studies primary aim assessed the
groups in many countries. Supportive psychometric properties of mother’s
programs provide the right, new and perceived Breastfeeding support. The
scientific information for mothers, and applied keywords were: (Breastfeeding
make them aware of the experiences of support OR breastfeeding social support
other mothers. Some of the objectives of OR breastfeeding family support) AND
these groups are to promote breastfeeding, (reliability OR validity OR psychometrics
support for mothers, and the pleasure of OR validity OR reliability OR factor
breastfeeding (14). In order to perform and analysis OR exploratory factor analysis

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Babakhanian et al.

OR confirmatory factor analysis OR CFA in details to extract the required data using
OR EFA OR Cronbach's alpha OR test- standardized data extraction form,
Retest reliability OR predictive validity). containing the name of first author,
We also checked the bibliographies of location of study, age of participants, date
related articles to detect any studies not of study, method of sampling, type of
retrieved via the above mentioned study, sample size, study population.
electronic databases. In the present review,
2-4. Quality of study
the bibliography of searched articles was
studied to find studies not retrieved Consensus based standards for the
through the electronic databases. selection of health status Measurement
instruments (COSMIN) checklist was used
2-2. Selection criteria
to assess the quality of related studies (19).
All instruments measured brestfeesing The checklist contained internal
family and social support of mothers consistency, reliability, measurement error,
published in Endlish databases. Also, content validity, structure validity, and
perimary aim of instrument was to assess hypothesis testing, cross cultural, criterion,
psychometric properitcs. responsiveness, interpretability and
generalizability.
2-3. Data extraction
The all related articles were evaluated
independently by two separate reviewers

Fig.1: PRISMA flowchart of present study.

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Psychometric Properties of Breastfeeding Support of Mothers

3-RESULTS mothers". The PBSAT with 29-item

Table.1 showed the characteristic and revealed an acceptable inter-rater
reliability of 0.95.
quality of four studies included into
systematic review. Figure.1 showed 3-1-2. Reliability
search process of included articles in
Reliability was tested by internal
systematic review. At first, 826 studies consistency reliability coefficient. Total
found primarly search; 822 studies
Cronbach's alpha was 0.85. The
excluded after reading title and abstract;
Cronbach’s alpha of first factor was 0.86
Finally, four questionnaires included in and second factor was 0.77. All obtained
systematic review.
value was in a normal range. Also,
3-1. Perceived Breastfeeding Support correlation each item with its factor’ sum
Assessment Tool’ (PBSAT) (15). were assessed. Item-first factor correlation
was significant and ranged from 0.48 to
Hirani et al. in Pakistan developed a 29- 0.77. Item-second factor correlation was
item tool named Perceived Breastfeeding significant and ranged from 0.26 to
Support Assessment Tool’ (PBSAT). This 0.71(15).
instrument measured Pakistani urban
working mothers’s preception regarding 3-2. Exclusive breastfeeding social
brestfeeding support. These questionnaire support (EBFSS) (16)
included two factors "workplace Boateng et al. in Uganda developed a 16-
environmental support for breast-feeding item tool named exclusive breastfeeding
working mother" and "the available social social support (EBFSS) (16). The response
environmental support for working to each item was measured on three-point:
mothers. Following Psychometric a) "no help at all", (b) "less than you would
properties was used to valid and reliable of like", and (c) "as much as you would like".
instrument (15). Validity of questionnaire was assessed
3-1-1. Exploratory factor analysis (EFA) construct validity (EFA and CFA),
predictive validity, and convergent
EFA was conducted on 41 items. The validity. Reliability was assessed using
Kaiser-Meyer-Olkin (KMO) was tested internal consistency.
before EFA to assess adequacy of sample
size. KMO was 0.762. EFA was conducted 3-2-1. Exploratory factor analysis (EFA)
using principle component analysis (PCA), EFA using Geomin oblique rotation was
and identified 12 factors with Eigen values conducted on 18 items. A three- factors
more than one. These identified factors solution was yield. Eigenvalue value of the
explained 62% of total variance. However, third first factor was 8.93, 1.66, and 1.28
screen plot identified two factors. The two explained 66%. Scree plot confirmed a
first Eigen value was 7.36 (17.96 three-factor solution with eigenvalue more
variance), and 3.13 (7.64% of variance). than one. One item with low factor
Factor loading below 0.34 or cross loading loading (<0.40), and one item with loading
more than 0.2 was removed; 29 out of 41 cross (>0.4) were removed. The remaining
items remained. Authors decided that 16 items group into three factors. These
factors structure of PBSAT should be two three factors labeled "instrumental",
factors. The first factor labeled "workplace "emotional" and "informational factors".
environmental support for breast-feeding EFA followed by confirmatory factor
working mother", and the second factor analysis (CFA). Three -factor model was
labeled to "the available social satisfactory fitted to the data (The Root
environmental support for working Mean Square Error of Approximation

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Babakhanian et al.

[RMSEA=0.07], Comparative Fit Index "breastfeeding-friendly environment",

[CFI=0.97], Tucker-Lewis Index "facility support", and "peer support
(TLI=0.95), Standardized root mean instrument". Each item was measured by a
square [SRMS= 0.06](16). seven point- Likert.
3-2-2. Confirmatory Factor analysis 3-3-1. EFA
Extracted three –factor solution of EFA KMO was 0.71 which is higher acceptable
were tested using CFA. CFA was value of 0.6. EFA using the principal
conducted on data from 3 months (n=237) component factor with rotation identified
post-partum. Initial model was partially four dimensions of breastfeeding support
fitted to the data. Base on modification at workplace. Eigenvalue for the first four
indices (16). factors was 3.58, 1.57, 1.19 and 1.11.
These four factors explained 62% of total
3-2-3. Reliability
variance. These four factors labeled
Cronbach's alpha was 0.78, 0.85, and 0.78 "technical support", "breastfeeding-
for instrumental, emotional, and friendly environment", "facility support"
informational of EBFSS scales at Month and "peer support"(17).
one. Cronbach's alpha was 0.78, 0.85, and
0.83 for instrumental, emotional, and 3-3-2. Reliability
informational of EBFSS scales at Month The reliability of the WBSS was measured
three (16). using internal consistency (Cronbach’s
alpha), and split-half reliability.
3-2-4. Predictive validity
Cronbach’s alpha was 0.77 and split-half
Predictive validity showed that three reliability was r=0.8617) (17).
factors of "instrumental" (β=1.79;
p<0.001), "informational" (β=1.29; 3-4. Employee Perceptions of
p<0.001), and "emotional" (β=1.33, Breastfeeding Support Questionnaire
p<0.001) of EBFSS predicted significantly (EPBS-Q) (18)
exclusive breastfeeding self‐efficacy Green et al. (18). in America designed and
(EBF). However, only "emotional" factor developed a 41-item instrument labeled
of EBFSS was significantly associated to Employee Perceptions of Breastfeeding
EBF behavior (16). Support Questionnaire (EPBS-Q). Items
3-2-5. Convergent validity were rated either yes/no or Likert scale.
Pilot test result in reducing initial item
General social support showed a statistical pool from 54 to 41 items. Questionnaire
significant correlation with instrumental (r divided into five sub-scales including
= 0.41, p ≤ 0.001), Informational (r = 0.15, physical environment of breast-feeding
p ≤ 0.05), and Emotional (r = 0.25, p ≤ space, company policies, co-worker
0.001) EBFSS (16). support, manager support and work- flow.
3-3. The Workplace Breastfeeding Data scaled by the Multidimensional
Support Scale (WBSS) Random Coefficients Multinomial Logit
Model. A two-dimensional model
BAI et al. (17) in America designed and (company polices/work culture and
developed instrument to measure mother’s manager and her co-workers) were
perception of Breastfeeding Support in emerged. Cronbach’s alpha was excellent
workplace. They called their instrument (almost 0.90). A moderately strong
"The Workplace Breastfeeding Support correlation were observed between two
Scale (WBSS)"; 12-item "group into four subscale (18).
factor including technical support",

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Psychometric Properties of Breastfeeding Support of Mothers

4- DISCUSSION correlation (18). Based on Exploratory

The infants commonly meet their Factor Analysis (EFA), the 29-item
PBSAT consists of two domains, including
nutritional needs thoroughly by
workplace environmental support with 12
breastfeeding. Nevertheless, this essential
source is in descending trend, especially items and social environmental support
with 17 items. The present study compared
among the newborns with employed
the two-factor solution with the four-factor
mothers, so that minimal or absent social
and occupational support reportedly makes solution by the EFA. The two-factor
solution rejected the four-domain based
it difficult to ensure the significance of
theoretical framework. The reliability was
exclusivity and continuation of
breastfeeding. Accordingly, a tested by internal consistency reliability
coefficient. Total Cronbach's alpha was
comprehensive, reliable and validated
0.85. The Cronbach's alpha of first factor
instrument to assess perceived
breastfeeding support, is required to deal was 0.86 and second factor was 0.77. Item-
first factor correlation ranged from 0.48 to
with this concern on breastfeeding support
0.77. Item-second factor correlation ranged
for working mothers (15). Due to the low
rate of breastfeeding among working from 0.26 to 0.71 (15). The study sample
size was calculated to be 200 among the
mothers and support of interventions to
breastfeeding employed mothers in urban
increase the duration of breastfeeding, this
systematic review conducted to evaluate areas. According to the reports, the least
subject to item ratio is better to be 5:1 in
psychometric properties of instruments
EFA (15), confirming the adequacy of 200
measured mother’s perception of
Breastfeeding Support. Four studies were breastfeeding employed mothers for this
study. The PBSAT was evaluated among
incded into systematic reviwe. Two studies
large sample size of the breastfeeding
were conducted in America, one study in
employed mothers in urban areas.
Uganda and one study in Pakistan. Three
studies assessed perceived breastfeeding In exclusive breastfeeding social support
support of working mothers. Four (EBFSS) instrument (15), based on
instruments PBSAT (15), EBFSS exploratory factor analysis, 16 items
(16),WBSS (17), and EPBS-Q to measur grouped into three factors "instrumental",
mother’s perception of brestfeeding "emotional" and "informational factors"
supporte were found to have sutiable accounted 66% of total variance. EFA
validity and reliabelity (18). were followed by confirmatory factors
analysis showed Modified model was
The PBSAT (15) had a suitable factorial
partially fitted to the data. The third
structure and good reliability. In term of
validity, EBFSS instrument had a defined- questionnaire was a 12-item instrument
labeled. The Workplace Breastfeeding
well EFA. CFA was confirmed on three–
Support Scale (WBSS). Four factors
factor model proposed by EFA that
showed a partial fit to the data and good explained 29.8% of total and labeled
"technical support", "breastfeeding-
predictive and convergent validity. This
friendly environment", "facility support"
instrument had a moderate reliability.
WBSS (17) had a defined –well EFA. and "peer support". The Cronbach’s alpha
was 0.77 and split-half reliability (r) was
Cronbach’s alpha and split-half reliability
0.86 (17). An advantage of WBSS is the
of WBSS was 0.77 and 0.861,
respectively. EPBS-Q (18) had two- short length. BAI et al. argued that the
"technical support" factor with three items
dimension. In term of reliability,
explained the greatest variance (29.8%).
Cronbach’s alpha was excellent and two
subscale had a moderately –strong The WBSS scale might be improved by

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Babakhanian et al.

adding more items in the "technical 6- CONFLICT OF INTEREST: None.

support" factor. The added four possible
items included "accessibility to hand- 7- REFERENCES
washing devices", "accessibility to electric 1. Mirmohammad AM, Bahiraii A, Rahimi A,
outlets for breast pumping", "accessibility Hashemzadeh M, Sohrabi N, Sohrabi Z. Effect
to separate refrigerators for storing breast of educational package on breastfeeding self-
milk away from employees", and efficacy in postpartum period. PAYESH.
"accessibility to on-site lactation support" 2014 ; 13(2): 221-28.
(17). The fourth questionnaire was a 54- 2. Funkquist EL, Tuvemo T, Jonsson B,
item instrument labeled EPBS-Q (18). A Serenius F, Nyqvist K. Preterm appropriate for
two-dimensional model (company gestational age infants: size at birth explains
polices/work culture and manager and her subsequent growth. Acta Paediatrica.
co-workers) was emerged. Internal 2010;99(12):1828-33.
consistency was excellent and correlation 3. Ulfah RRM. Efektivitas Pemberian Teknik
between two subscales was moderately Marmet Terhadap Pengeluaran ASI Pada Ibu
strong (18). This questionnaire had two Menyusui 0-6 Bulan di Wilayah Kerja
key limitations that should be addressed. Puskesmas Arjasa Kabupaten Jember. 2013.
First, EPBS-Q with 54 items may be Available at:
considered a relatively long-term http://repository.unej.ac.id/bitstream/handle/12
questionnaire. Second, the sample size 3456789/9987/
(n=104) of study was relatively small. 4. Niela-Vilén H. Breastfeeding preterm
4-1. Limitation infant from the delivery ward via NICU to
home. 2016. Available at:
The limitations of systematic review need https://www.researchgate.net/profile/Hannakai
to be addressed. First, psychometric sa_Niela-Vilen
properties of the instruments were not 5. Agustina I. Gambaran Pengetahuan Dan
comprehensively tested. Further researches Sikap Ibu Bekerja Terhadap Upaya
required to be conducted based on Pemenuhan Kebutuhan Asi Eksklusif Di Smk
COSMINE checklist. In term of the test- Negeri 6 Makassar. Available at:
retest reliability, it was not reported in http://repositori.uin-alauddin.ac.id/4112/.
none of questionnaires. Missing 6. Varaei S, Mehrdad N, Bahrani N. The
percentage of items and how they were Relationship between Self-efficacy and
handled were not reported in some studies. Breastfeeding, Tehran, Iran. Hayat.
Adequacy of sample size in factors 2009;15(3): 31-8.
analysis can be determined based on rule 7. Yaghini SO, Khameh S, Danesh F,
of thumb and Monte Carlo according to Modaresi MR, Saneian H. Determinants of
rule of thumb, at least five cases for each Exclusive Breast Milk Feeding of Infants in
items are need to conduct EFA. Therefore, Isfahan, Iran. Journal of Isfahan Medical
it seems that sample size included in some School. 2011;28(117): 1126-38.
studies was insufficient.
8. Gafari Asl M, Fadakar Sogheh R, Ghavi A.
Related factors to continued breastfeeding in
5- CONCLUSIONS infants. Journal of Holistic Nursing And
PBSAT, EBFSS, WBSS and EPBS-Q Midwifery. 2014;24(2):1-8.
are valid and reliable instruments to 9. Hajnasiri H. Assessment of Breastfeeding
measure mother’s perception of Self-Efficacy and Patterns and its Predictors in
breastfeeding support in family, social and Mothers Living in Qazvin Province. The J
workplaces. These instruments can be used Urmia Nurs Midwifery Fac. 2018;15(10):777-
in clinical and research setting. Future 87.
work should be done in diverse population.

Int J Pediatr, Vol.7, N.1, Serial No.61, Jan. 2019 8827

Psychometric Properties of Breastfeeding Support of Mothers

10. Parsa P, Boojar A, Roshanai G, Bakht R. 15. Hirani SAA, Karmaliani R, Christie T,
The Effect Breastfeeding Counseling on Self- Parpio Y, Rafique G. Perceived Breastfeeding
Efficacy and Continuation Breastfeeding Support Assessment Tool (PBSAT):
among Primiparous Mothers: A Randomized Development and testing of psychometric
Clinical Trial. 2016; 24(2): 98-104. properties with Pakistani urban working
mothers. Midwifery. 2013;29(6):599-607.
11. Blyth RJ, Creedy DK, Dennis C-L, Moyle
W, Pratt J, De Vries SM, et al. Breastfeeding 16. Boateng GO, Martin SL, Collins SM,
duration in an Australian population: the Natamba BK, Young SL. Measuring exclusive
influence of modifiable antenatal factors. breastfeeding social support: Scale
Journal of Human Lactation. 2004;20(1):30-8. development and validation in Uganda.
Maternal & child nutrition. 2018:e12579.
12. Leung GM, Lam T-H, Ho L-M. Breast-
feeding and its relation to smoking and mode 17. Bai Y, Peng C-YJ, Fly AD. Validation of a
of delivery. Obstetrics and Gynecology. short questionnaire to assess mothers'
2002;99(5):785-94. perception of workplace breastfeeding support.
Journal of the American Dietetic Association.
13. Pérez-Escamilla R, Maulén-Radovan I,
2008;108(7):1221-25.
Dewey KG. The association between cesarean
delivery and breast-feeding outcomes among 18. Greene SW, Wolfe EW, Olson BH.
Mexican women. American journal of public Assessing the validity of measures of an
health. 1996;86(6):832-6. instrument designed to measure employees'
perceptions of workplace breastfeeding
14. Tork Zahrani S, Karamollahi Z, Azgoli G,
support. Breastfeeding Medicine.
Akbarpur Baghian A, Sheikhan Z. Effect of
2008;3(3):159-63.
support from the mothers with positive breast
feeding experience on breast feeding pattern 19. Mokkink L, Terwee C, Patrick D, Alonso
and duration among primiparous women J, Stratford P, Knol D. COSMIN checklist
referred to maternityward of Ilam hospital, manual. Amsterdam: COSMIN; 2012 [Cited
2010. Scientific journal of ilam university of 2016 Nov 2].
medical sciences. 2012;20(2):9-16.

Int J Pediatr, Vol.7, N.1, Serial No.61, Jan. 2019 8828

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Table-1: The characteristic and quality of four studies included into systematic review
Authors,
Timing
Reference, Age, Sample size Type of studies
Instrument Study population. administration of A B C D E F G H I J K
Area of study, Year
test
Reference
BAI, 2 () () (1) (3) () () () () () (2)
American
References (17) 66 mothers 6 to 12 months
27.7±5.8 WBSS Primiparous Cross-sectional
2008, postpartum
mothers.
American
Hirani, Working mothers 2 () () (1) (3) () () () () () (2)
Reference (15), Pakistani urban
200 breast-
2012, working mothers
feeding Methodological
Pakistan 19-45 PBSAT had babies who Post partum
working research
were less than or
mothers
equal to 12
months.
Boateng, 1 (n = 238), 2 () () (1) (3) () () () () () (2)
Reference (16), and 3 (n = Observational 1 and 3 months
25.2 EBFSS Uganda mothers.
2017, 237) months cohort Post partum
Uganda post‐partum
Greene, American - 2 () () (1) (3) () () () () () (2)
References (18), pregnant mothers Pregnancy or
30.5 EPBS-Q n=104
2007, or had recently postpartum
America delivered.
Empty boxes=not applicable, 0=poor, 1=good, 2= fair, 3=good and 4=excellent.
A: Internal consistency; B: Reliability, C: Measurement error; D: Content validity; E: Structural validity, F: Hypothesis testing, G: Cross cultural, H: Criterion; I:
responsiveness; J: Interpretability; K: Generalizability.
PBSAT: Perceived Breastfeeding Support Assessment Tool; EBFSS: Exclusive breastfeeding social support; WBSS: The Workplace Breastfeeding Support Scale; EPBS-Q:
Perceptions of Breastfeeding Support Questionnaire.

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