Breastfeeding Self-Efficacy Scale—Short Form (BSES-SF)

Abstract

The Breastfeeding Self-Efficacy Scale—Short Form (BSES-SF) is a widely used, psychometrically sound instrument designed to measure a mother’s confidence in her ability to successfully initiate and sustain breastfeeding. Developed by Cindy-Lee Dennis in 2003, it is a concise 14-item adaptation of the original 33-item Breastfeeding Self-Efficacy Scale (BSES). The scale is grounded in Self-Efficacy theory, assessing perceived competence across various domains related to lactation management, coping with challenges, and maintaining motivation. The BSES-SF provides a quick, reliable measure for clinical and research settings, helping to identify mothers at risk for early cessation of breastfeeding.

Keywords

Breastfeeding, Self-Efficacy, Maternal Confidence, Lactation, Postpartum, Psychological Assessment, BSES-SF, Psychometrics

Authors

Cindy-Lee Dennis, Sandra Faux

Purpose

The primary purpose of the Breastfeeding Self-Efficacy Scale—Short Form (BSES-SF) is to quantify the level of maternal self-efficacy specifically related to breastfeeding. By measuring confidence, the instrument aims to predict the initiation, duration, and exclusivity of breastfeeding practices.

In clinical practice, the BSES-SF serves as an effective screening tool, allowing healthcare providers, such as nurses and midwives, to identify mothers who may require enhanced support or targeted interventions to boost their confidence and address specific perceived barriers to successful breastfeeding. High self-efficacy scores are consistently associated with longer breastfeeding duration.

Construct

The BSES-SF measures self-efficacy, which, according to Bandura’s social cognitive theory, refers to an individual’s belief in their capacity to execute behaviors necessary to produce specific performance attainments. In the context of the BSES-SF, this construct centers on the mother’s belief in her ability to master various tasks associated with breastfeeding, ranging from practical skills to coping mechanisms and emotional perseverance.

The construct is generally understood to encompass both technical mastery (e.g., proper latch and positioning) and coping ability (e.g., managing time constraints or crying babies). This assessment of perceived competence is crucial because self-efficacy is a stronger predictor of behavior than outcome expectancies alone.

Validity

The BSES-SF has demonstrated strong evidence of validity across diverse populations. Content validity was established during the development of the original 33-item scale through expert review.

Construct validity is supported by confirmatory factor analysis, which confirms that the items appropriately load onto the intended theoretical dimensions (often Technique and Intrapersonal/Coping domains). Furthermore, the scale exhibits excellent criterion validity, showing significant correlations with actual breastfeeding outcomes, such as duration and exclusivity, in the postpartum period.

Reliability

The BSES-SF is recognized for its high internal consistency, indicating that the items reliably measure the same underlying construct. Studies have consistently reported high Cronbach’s alpha coefficients, typically ranging from 0.86 to 0.94, suggesting strong reliability across various samples and cultural contexts.

Test-retest reliability is also generally strong, confirming the stability of the measure over short periods, particularly when administered during the immediate postpartum phase. This high level of reliability ensures that the scale provides a consistent measure of maternal self-efficacy.

Factor Analysis

The original 33-item BSES was developed based on a three-factor solution: Technique, Intrapersonal Thoughts, and Support. However, the 14-item BSES-SF, developed in 2003, typically yields a two-factor structure or is sometimes utilized as a unidimensional scale measuring overall confidence.

The two primary factors often identified in the short form are: 1) Technique (focusing on practical skills like latching, positioning, and milk supply management); and 2) Intrapersonal/Coping (focusing on emotional management, motivation, and dealing with challenges like time consumption or public feeding). This factor structure supports the comprehensive nature of the self-efficacy construct in this domain.

Instrument

Test Type: Self-report scale (Psychological/Behavioral Assessment)

Format: 14 items, measured on a 5-point Likert Scale.

Language Available: English (Original), widely translated into numerous languages including Spanish, Chinese, Turkish, and French.

Population Group: Pregnant and Postpartum Women.

Age Group: Adults (Mothers of childbearing age).

Population Details: Primarily used with primiparous and multiparous women, administered during the prenatal period, immediately postpartum (24–72 hours), and up to 8 weeks following delivery.

Test Methodology: Respondents rate their confidence in performing specific breastfeeding behaviors using the following response options:

• 1 = not at all confident
• 2 = not very confident
• 3 = sometimes confident
• 4 = confident
• 5 = very confident

Scores are summed, with a higher total score indicating greater breastfeeding self-efficacy.

Keywords

Maternal Health, Confidence Scale, Lactation Support, Infant Feeding, Psychometrics, Nursing Research, Health Psychology

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: Not provided in source content.

Correspondence Address: Not provided in source content.

Permissions & Fee and Test Year

The scale was first published in its full form (BSES) in 1999, and the Short Form (BSES-SF) was formally published and validated in 2003. The scale is generally available for non-commercial research use, though users should consult the primary author (C. L. Dennis) or her institutional resources for formal permission regarding specific applications.

Information regarding the instrument can be found on the author’s research page: http://www.cindyleedennis.ca/research/1-breastfeeding/breastfeeding-self-efficacy/. Additional validation studies are available through academic databases.

Reference’s

• Dennis, C. L., Faux, Sandra. (1999). Development and Psychometric Testing of the Breastfeeding Self-Efficacy Scale. Research in Nursing & Health, 22, 399–409.
• Dennis, C. L. (2003). The Breastfeeding Self‐Efficacy Scale: Psychometric Assessment of the Short Form. Journal of Obstetric Gynecologic Neonatal Nursing, 32(6), Pages 734–744.
• Dennis, C. L. (2006). Identifying predictors of breastfeeding self-efficacy in the immediate postpartum period. Research in Nursing & Health, 29, 256-268. doi:10.1002/nur.20140.
• Dennis, C. L. (2010). Clinical utility of the breastfeeding self-efficacy scale. Retrieved from http://www.cindyleedennis.ca/research/1-breastfeeding/clinical-utility-of the-breastfeeding-self-efficacy-scale.
• Additional academic work related to the instrument can be found here: http://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=2863&context=dissertations and https://www.researchgate.net/publication/227834784.

Items of the Breastfeeding Self-Efficacy Scale—Short Form (BSES-SF)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way. These 14 items constitute the Short Form (BSES-SF).

1. I can always determine that my baby is getting enough milk
2. I can always successfully cope with breastfeeding like I have with other challenging tasks
3. I can always breastfeed my baby without using formula as a supplement
4. I can always ensure that my baby is properly latched on for the whole feeding
5. I can always manage the breastfeeding situation to my satisfaction
6. I can always manage to breastfeed even if my baby is crying
7. I can always keep wanting to breastfeed
8. I can always comfortably breastfeed with my family members present
9. I can always be satisfied with my breastfeeding experience
10. I can always deal with the fact that breastfeeding can be time consuming
11. I can always finish feeding my baby on one breast before switching to the other breast
12. I can always continue to breastfeed my baby for every feeding
13. I can always manage to keep up with my baby’s breastfeeding demands
14. I can always tell when my baby is finished Breastfeeding