Assessing the impact of midwives' instruction: The breastfeeding motivational instructional measurement scale

Background. It has been reported that professional support is an important motivational factor in breastfeeding outcomes, however evidence suggests this is not necessarily the case. For women to be motivated through routine instruction, the optimal balance between value of breastfeeding with expectancy for success must be achieved. Aim. To develop and test the breastfeeding motivational instructional measurement scale (BMIMS) as a means of exploring the value and expectancy for success (confidence) that breastfeeding women experience when receiving best breastfeeding practice. Method. Informed by current literature and previous exploratory work, four motivational theories were incorporated into the BMIMS. A total of 14 items represented the Breastfeeding Self-efficacy Scale - Short Form. The remaining 37 items were transcribed from a previous task-motivation study. The resulting 51-item scale was exposed to expert review. Following ethical approval and verbal consent, the scale was pilot-tested (n=20) and completed via structured interview by a further convenience sample of breastfeeding women (n=182). Results. Exploratory factor analysis - an analytic technique for exploring underlying constructs or factors - was performed. Parity was used as a selection variable. The results revealed that first-time mothers highly valued the experience of breastfeeding, but low expectancy for success and a low perception of midwife support. Experienced mothers differed in that they reported a positive expectancy for success and were more moderate about the value they placed on breastfeeding. Conclusions. When value is high and expectancy for success is low, feelings of stress related to the behaviour often results. Although all mothers reported a perceived lack of midwife support, experienced mothers were empowered to sustain their expectancy for success. Current best practice must work to achieve the optimal motivational balance between value and expectancy for success in primigravida women.