Poster #49 - The Development and Validation of the (CARE) Lactation Inventory: Considerations for Advocacy, Resources and Empowerment upon Return-to-Work

• In Event: Poster Session 13

Abstract

Background: Returning to work after childbirth is associated with lactation cessation. This is concerning as there are a myriad of health benefits associated with lactation for parent and child. Self-efficacy has been identified as a crucial component for achieving lactation goals and recommendations. However, currently no measures exist that evaluate lactation self-efficacy upon return-to-work. Therefore, the purpose of this study was to describe the development and validation of a self-efficacy measure designed to assess lactation self-efficacy upon return-to-work. Methods: The measure was developed by employing self-efficacy theoretical constructs (i.e., performance accomplishments, vicarious experiences, verbal persuasion and physiological response), current lactation literature and content expertise. The development of the CARE (Considerations for Advocacy, Resources and Empowerment) Lactation Inventory underwent three phases: item development, scale development and scale evaluation. Item development consisted of literature review, content validity testing with an expert panel of 6 (2 PhDs; 4 MS RDs) followed by cognitive interviews with lactating individuals (n=4). Scale development included content validity testing with a second expert panel of 5 Certified Lactation Counselors (CLCs). Scale evaluation took place with 64 currently lactating individuals who were employed at least 30 hours per week. Individuals completed the revised CARE Lactation inventory as well as the General Self-Efficacy Scale (GSES) via a cross-sectional electronic survey link. Scale internal consistency was measured via Cronbach Alpha analysis followed by construct validity via a confirmatory factor analysis. A known group analysis was conducted comparing currently working parent responses with responses from individuals still on maternity leave and correlational analysis between the CARE Inventory and GSES. Results: Four items were eliminated during the item development stage upon the confirmatory factor analysis. The remaining 13 items underwent scale development in which minor wording/phrasing changes were completed based on edits provided by the content experts. The scale evaluation determined the final 13-item CARE Lactation Inventory had satisfactory internal consistency α =.89 and construct validity. The known group analysis identified a significant difference in mean self-efficacy between those currently working (76.9±15.1) and those currently on maternity leave (65.0±11.5); t(53)=3.07, p<.05. Finally, a Pearson correlation analysis suggested a positive moderate correlation between CARE and GSE scores r=.68, (p<.005). Discussion: The CARE lactation inventory has demonstrated satisfactory internal reliability and construct validity. This measure has the potential to be a valuable tool for childcare/workplace interventions targeting lactation support efforts. This is also one of a few lactation research measures to utilize inclusive language (e.g., human milk vs breast milk). Further research is needed to determine its predictive value related to lactation behaviors after return to work however this instrument could serve as a valuable tool to facilitate discussions, education and resource sharing between a lactating individual and their childcare or healthcare provider.

Authors

• Kailey Snyder, University of Nebraska Medical Center (UNMC)
  Presenting Author

• Audra Losey, University of Nebraska Lincoln

• Danae Dinkel, University of Nebraska at Omaha