Self-Efficacy Theory-Based Instrument to Measure Prenatal Breastfeeding Self-Efficacy & Breastfeeding Intention Among Pregnant Women

It was 2015 when Erin McKinley, PhD, RD, LD, CLC, CHES, formerly Erin Patenaude, claimed the Milk Duck throne. Since then– what McKinley says feels like a lifetime ago– much has changed.

“I finished my PhD at The University of Alabama in August 2017, which was my most satisfying accomplishment to date,” she says.

McKinley will present “Development & Validation of a Self-Efficacy Theory-Based Instrument to Measure Prenatal Breastfeeding Self-Efficacy & Breastfeeding Intention Among Pregnant Women” at the upcoming International Breastfeeding Conference in Deerfield Beach, Fla. Her presentation is based on research completed for her dissertation.


McKinley explains: “There are a fair number of survey instruments available to measure the concept of breastfeeding self-efficacy and in my argument to justify creating this survey tool I was not at all trying to say the available instruments are not useful, I just had a hunch that things could be measured differently for pregnant women.

“It ruffled a few feathers among some that work in this area of breastfeeding research, but I think what I have adds to the body of instruments nicely,” she goes on.

McKinley says she was excited to give the instrument a catchy acronym name – PREP to BF (Prenatal Rating of Efficacy in Preparation to Breastfeed.)

“Coming up with acronyms for survey instruments is an art form in itself,” she says.

Because it was her dissertation study, McKinley was crunched for time and had to use an easily accessible sample in her area. She admits that overall, the study is small in scale, but says there are plans to re-test the survey among a larger sample in Louisiana.

Karin Cadwell, Executive Director of Healthy Children’s Project’s Center for Breastfeeding, participated on McKinley’s panel of experts for the initial review of the instrument.

“Thanks again Dr. C!” McKinley shouts out.

Throughout data collection, McKinley reports some participants casually conversing with her about their breastfeeding plans or experiences.

“I had one mom who was pregnant with baby 7 and had successfully breastfed all of her children for at least one year,” McKinley recalls. “That was so awesome to hear!”

McKinley says she was struck by the statistical model that resulted after running the exploratory factor analysis on survey data to see how the survey questions grouped together.

“It is very different than I had thought it would look – which was exciting,” she begins. “My mentor and I just looked at each other like, ‘We have a cool, new model! This is awesome!’”

Coming soon

McKinley hopes researchers will use PREP to BF among samples outside of southern United States to see how data may vary.

PREP to BF is currently being translated into Spanish, and McKinley has plans to run a pilot test on the Spanish version in Spring 2019.

A larger study using PREP to BF where mothers are followed up to 12 months postpartum is tentatively scheduled to begin in late 2019.  

“I would love to see if the instrument has predictive validity of initiation, duration and exclusivity,” McKinley says.   

Curricula influenced by breastfeeding

In March 2018, McKinley became a faculty member in the School of Nutrition and Food Sciences at Louisiana State University (LSU) where she teaches and continues her research. She’s also the Director of the Didactic Program in Dietetics where she manages the 132-student dietetics major that prepares students to go into Dietetic Internships to become Registered Dietitians.

McKinley exclaims, “I warn students on the first day that I talk a lot about breastfeeding!”

She goes on to say, “My students never cease to amaze me; it makes for a fun work environment.”

Coffee shop conversations

Reflecting on changes within maternal child health, McKinley takes note of improvements in breastfeeding support.

In La., she says she often sees ads for community breastfeeding events. Hospital administrators have shared with her that increasing breastfeeding rates and decreasing maternal mortality rates are at the top of their strategic plans. LSU  is currently increasing availability of clean, private, on-campus lactation spaces for students, faculty, staff, and guests.

“It was an initiative I was quick to jump in on and support, not just as a CLC and researcher, but also as an all-around breastfeeding advocate,” McKinley says.  “I am excited to see how moms react to the new spaces and to research how they are utilized.”

Overall, McKinley reports having noticed a collective increase in the support of breastfeeding in the U.S.  

“Back in 2014, when I would mention that I did my research in the area of breastfeeding and lactation, it did not seem to turn too many heads,” she begins. “Now when I mention it, folks’ ears perk up and immediately want to know more about my work…I see this everywhere from students, faculty and staff in the LSU community to people overhearing me talking to my husband at a coffee shop or in line at the grocery store and just have to interrupt to tell me about their breastfeeding journey or their daughter/granddaughter’s journey. Moreover, it always ends with positive support to ‘keep doing what I am doing because it’s important.’”

McKinley continues:  “When the news broke this past summer about the attempt by the U.S. to block the pro-breastfeeding resolution at the World Health Assembly, I saw an outpouring of public support for breastfeeding in a way I had yet to see. People were fired up! I hope the momentum to support breastfeeding continues.”  

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