Assessing the Psychometric Strength of the Chinese Version of the Existential Breastfeeding Difficulty Scale: A Dual Approach Using Classical Test Theory and Item Response Theory

Problem: Challenges faced during the initial phase of breastfeeding contribute significantly to the cessation of exclusive breastfeeding among mothers within the first 6 months. Therefore, evaluating these challenges from a psychological perspective has immense clinical and research importance. Background: The Existential Breastfeeding Difficulty Scale (ExBreastS) is a self-reported questionnaire designed to assess the psychological challenges of mothers during early breastfeeding. Its reliability and validity has been tested in Sweden and Turkey based on the classical test theory. Aim: This study aims to translate and culturally adapt the ExBreastS into Chinese, while incorporating the classical test theory and item response theory to comprehensively evaluate the scale's psychometric properties. Methods: This was a cross-sectional study. After completing the translation and cross-cultural adaptation of the ExBreastS, 520 participants were recruited between January and April 2024. The participants, were 0-3 months postpartum, had singleton-term deliveries, were breastfeeding, and completed the Chinese version of the ExBreastS. Afterwards, the psychometric properties of the ExBreastS were thoroughly evaluated. Findings: The Cronbach's alpha coefficient for the ExBreastS was 0.884, with subscale coefficients ranging from 0.757 to 0.824. The difficulty parameters for each item ranged from -1.125 to 4.072, and the discrimination parameters ranged from 1.048 to 3.339. Furthermore, this scale exhibited substantial measurement information when latent trait levels were between -2 and 4. Discussion and conclusion: The Chinese version of the ExBreastS is reliable for evaluating early breastfeeding challenges in mothers, and could aid healthcare professionals in screening and identifying mothers at risk of discontinuing breastfeeding.