Breastfeeding self-efficacy scale in Haitian women for chile: cross-cultural adaptation and validation

Abstract

Background

Migratory movements represent a global challenge, especially in public health, where cultural and linguistic barriers hinder care for vulnerable populations. In Chile, the Haitian community faces these limitations, which affect breastfeeding practices. Breastfeeding self-efficacy is a key predictor of success in this practice and is assessed by instruments such as the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF).

Objective

To perform a cross-cultural adaptation and psychometric evaluation of the BSES-SF in Haitian Creole.

Design and Methods

The scale was translated following a rigorous process of translation and back-translation, cultural validation, and application in a sample of 76 pregnant Haitian women treated in two health centers in Talca, Chile. Reliability was assessed via Cronbach’s alpha, and internal consistency was evaluated via intraclass correlation. Construct validity was assessed via exploratory factor analysis.

Results

The scale showed high reliability (Cronbach’s alpha = 0.943; intraclass correlation coefficient = 0.907). Factor analysis revealed two principal components that explained 70.14% of the total variance, with consistent values in both dimensions (Cronbach’s alpha values of 0.901 and 0.906).

Conclusions

The Haitian version of the BSES-SF is valid and reliable, providing a tool to assess and strengthen breastfeeding self-efficacy. This study contributes to developing culturally sensitive interventions and reinforces the importance of inclusive strategies in public health.

Clinical trial

Not applicable.

Introduction

The phenomenon of migration in Latin America (LA) has grown significantly in recent decades and is of global significance, driven by economic, labor, security, and social welfare factors [1]. This migration presents unique challenges, particularly in public health, where cultural and linguistic barriers hinder care for vulnerable populations [2, 3]. According to the 2017 Census, the immigrant population in Chile represents 4.35% of the total population, with the Haitian community being one of the most representative, accounting for 8.4% of the total number of foreigners. The unique challenges faced by the Haitian community, including cultural and linguistic barriers, have a significant impact on their health, particularly maternal and child health [4]. This increase in immigration has generated challenges in multiple areas, including public health [5, 6]. Migrant populations often face cultural, linguistic, and economic barriers that hinder their access to health services and affect their general well-being. These barriers are especially evident in maternal and child health, a high-priority area for health systems due to its impact on new generations’ long-term quality of life [7–9].

Exclusive breastfeeding (EBF) is essential to healthy child development, providing the nutrients necessary for growth and protecting infants from common diseases [10]. The World Health Organization (WHO) recommends EBF for the first six months of life and its continuation for up to two years, along with complementary foods [11]. In Chile, the national EBF rate is 57%, and the Ministry of Health (MINSAL) has set a goal of 60% for the first six months of life [12]. However, the increase in the immigrant population, especially Haitian women, poses specific challenges to achieving this goal. A recent study in the country revealed that only 35.3% of infants of Haitian mothers receive EBF during the first six months, a figure significantly lower than the WHO’s global goal of reaching a 50% EBF rate by 2025 [13].

In the case of the Haitian community, language, cultural adaptation, and limited access to health services influence breastfeeding (BF) rates [1]. For BF promotion policies to be effective in multicultural contexts, it is essential to understand the perceptions and needs of mothers in their own cultural and linguistic context [9, 14]. A central aspect in the promotion and success of BF is self-efficacy, a concept introduced by Albert Bandura in his social cognitive theory, which refers to a person’s perception of their ability to perform a specific task successfully [14]. In the context of BF, self-efficacy is understood as a mother’s confidence in her ability to breastfeed her child exclusively and continuously. This process is influenced by psychosocial factors and the mother’s mental health, and stress is recognized as a negative factor [15]. This impact may be even greater in vulnerable populations or migratory contexts.

To assess self-efficacy in breastfeeding, Dennis and Faux developed the Breastfeeding Self-Efficacy Scale (BSES) and its abbreviated version, the BSES-SF, which is a tool validated in multiple cultural contexts and allows the measurement of mothers’ confidence in their ability to breastfeed [16–23], and is applied to lactating and pregnant women to identify first-time or multiparous mothers with poor previous experiences, with low confidence in breastfeeding, and requiring additional assistance [23]. However, to date, no adaptation of this scale to Haitian Creole for use in Chile has been reported, which limits the ability of health professionals to assess and support Haitian mothers in this area adequately.

In this context, the present study, a collaborative effort between researchers, healthcare professionals, and policymakers, aims to perform a cross-cultural adaptation and psychometric evaluation of the Breastfeeding Self-Efficacy Scale (BSES-SF) in Haitian Creole. This adaptation provides a valid and reliable tool to assess the breastfeeding self-efficacy of Haitian mothers in Chile. It contributes to the scientific literature on the importance of culturally adapted instruments in migration contexts. The information obtained through this scale will allow health professionals to design more specific and culturally sensitive interventions, supporting Haitian mothers in their breastfeeding process and contributing to achieving breastfeeding goals in the country.

Methodology

Study design

The study’s cross-sectional design focuses on the psychometric validation of a culturally adapted instrument. This approach enables the assessment of the scale’s properties in a specific population at a time, which is suitable for establishing its reliability and validity. The cross-sectional design is beneficial in psychometric research, as it enables the simultaneous collection of data on the scale’s characteristics and participants’ perceptions [24].

The choice of a cross-sectional design was justified because it provides an instantaneous and accurate view of how participants interact with the adapted instrument. This design is also resource-efficient, allowing the scale to be administered and its psychometric properties to be analyzed without needing prolonged follow-up.

Population and sample

The study population consisted of pregnant Haitian women who were enrolled in primary health care centers in the commune of Talca in October 2018 and met the inclusion criteria. Owing to the characteristics of the study’s design and objectives, it was impossible to estimate the total population size. The methodological criterion recommended for psychometric studies was used to determine the sample size, as Roco-Videla et al. [25] indicated, which suggests that some participants are 5–10 times the number of items in the instrument. Since the BSES-SF consists of 14 items, the minimum sample size required was 70 participants. This study included 76 participants selected through convenience sampling, which allowed an adequate number of participants to be reached to ensure the stability of the statistical analyses. This sample size is sufficient to perform exploratory factor analysis (EFA) and reliability tests, such as Cronbach’s alpha and the intraclass correlation coefficient.

Selection criteria

The selected participants had to meet the following inclusion criteria: they were Haitian women between 26 and 36 weeks pregnant, able to perform the retest before delivery, aware of how to read and write in Creole, signed the informed consent form, and registered in health centers in the commune of Talca. The exclusion criteria included pregnant women with multiple pregnancies, pregnancies with high obstetric risk, premature births of the selected women, and pregnant women with cognitive problems. All participants signed an informed consent form, declaring their voluntary participation in the study.

Ethics committee approval and informed consent

The study was approved by the ethics committee of Santo Tomás University with code N° 134 − 18, and the consent of the project managers at the provincial level was obtained. The ethical principles for medical research (Declaration of Helsinki) were followed. Informed consent was obtained from all participants before their inclusion in the study, ensuring a complete understanding of the risks and benefits of the process through a translator employed by the health center where the participants received treatment.

Instrument

The short version of the Breastfeeding Self-Efficacy Scale (BSES-SF), consisting of 14 self-administered items, was used to measure breastfeeding self-efficacy. The scale was translated into Spanish [18], where Cronbach’s α coefficient was 0.92. Principal components analysis confirmed the unidimensional structure of the scale, with factor loadings greater than 0.30 for all items. The mean score on the BSES-SF scale obtained by women with previous breastfeeding experience who rated their experience as “very positive” was 57.33 ± 8.82, while the mean score obtained by women who rated their previous experience as “somewhat positive” or “quite positive” was 47.73 ± 12.04, and this difference was statistically significant (t = 3.51; p = 0.001).

Each item is rated on a 5-point Likert scale, where 1 indicates “very unsure” and 5 indicates “very sure”. The sum of the instrument corresponds to 70 points, equivalent to a maximum self-efficacy to breastfeed her child. On the other hand, the lowest score, corresponding to 14 points, is equivalent to a minimum self-efficacy in breastfeeding her child (Table 1).

Table 1.

The Spanish version of the breastfeeding Self-Efficacy Scale-Short form

No.	Reagent
1	I can determine that my child is getting enough milk from my breast.
2	I can successfully deal with breastfeeding just as I have dealt with other challenges in my life.
3	I can breastfeed my child without using milk formulas.
4	I can ensure that my child is properly attached to my breast while feeding.
5	I can manage the breastfeeding situation for my well-being.
6	I can handle the breastfeeding situation even if my child is crying.
7	I can maintain the desire to breastfeed.
8	I can breastfeed comfortably when my family members are present.
9	I can be satisfied with the breastfeeding experience.
10	I can face the fact that breastfeeding will take up my time.
11	Can I finish breastfeeding my baby on one breast before switching to the other breast?
12	I can breastfeed my child whenever he needs it.
13	I can meet my child’s breastfeeding needs.
14	I can recognize when my child has finished breastfeeding.

Source: Adapted from Dennis et al

Translation and cultural adaptation

The cross-cultural adaptation of the BSES-SF into Creole was carried out through translation and back-translation. To validate the content of the survey, two native speakers from Haiti who work as translators in health centers were first asked to translate the instrument independently. Both translators then combined both versions into a final translation into Creole. The Creole version was then translated into Spanish by a professional translator and compared to the original version to ensure semantic equivalence. A panel of 10 BF experts working at the BF desk in the regional ministerial health service (3 midwives, 4 nurses, 2 nutritionists, and a doctor) was then in charge of reviewing and approving the final translation, assisted by an official translator from the family health center. They all verified the cultural and linguistic coherence in the Haitian context, obtaining a content validity index (CVI) of 0.8.

Pilot study

A pilot study was conducted with 29 mothers who met the inclusion criteria. The purpose was to assess the comprehensibility and readability of the BSES-SF in Creole. Of the 14 items, 4 presented comprehension problems, so specific adjustments were made (e.g., changing “receiving” to “taking”) [21]. The interviews were conducted by dividing the pilots into three groups, supported by the researchers and the health center’s translators, who received training before administering the survey. Based on the pilot study’s observations, the final Creole version of the scale was established.

Validation procedure

The Creole scale was then applied to an additional sample of 56 women, yielding a total of 76 surveys after the responses from the pilot study were integrated. After 15 days, a second application was made to 10% of the sample to calculate the intraclass correlation coefficient and evaluate test-retest reliability [25].

Variables

The study’s main variables included self-efficacy in BF, measured through the short version of the BSES-SF, and sociodemographic variables such as age, level of education, marital status, number of children, and employment status. These variables were clearly defined and operationalized, aligning with the study’s objectives.

Statistical analysis

Data analysis was performed via SPSS (version 29). Descriptive analyses were performed (frequencies and percentages for discrete variables; means and standard deviations for continuous variables).

EFA was used via the principal component method because this population is unique and cannot be extrapolated. Furthermore, the EFA was employed because the various validations of the scale have yielded one-dimensional [26, 27] or two-factor [22, 28, 29] results. Therefore, the objective was to evaluate the performance for this specific population.

For this analysis, the Kaiser Mayer Olkin (KMO) criterion was used to determine sample adequacy. A minimum KMO value > 0.8 was expected to indicate that the sample was adequate for factor analysis. Communalities were considered to assess the relevance of each item to the scale. Communality values ​​h² > 0.5 indicated an adequate index of item belonging to the entire scale. Additionally, the existence of factors was assessed using Bartlett’s test of sphericity (p < 0.05). Eigenvalues ​​expected to be greater than 1 were subsequently evaluated to indicate the existence of the scale’s factors. The proportion of explained variance, expected to be > 50%, was also assessed. Oblimin’s oblique rotation was used, optimizing the distribution of loadings in each factor, and facilitating its interpretation to identify the most relevant factors. This type of rotation was also used because it is assumed that the scale’s factors are correlated. Factor loadings > 0.50 were expected to confirm that the item belonged to the specific factor. A final correlation of the obtained factors was also performed, where a correlation coefficient of > 0.32 was expected to be obtained to assume an association between the factors [30]. To assess scale reliability, Cronbach’s alpha analysis was used. A minimum reliability threshold of 0.70 was established for the scale to indicate acceptable reliability; α values ​​between 0.8 and 0.89 indicated good reliability, and α values ​​>0.9 indicated excellent reliability. Additionally, an intraclass correlation analysis was performed on the average measurements of the total scale. A 95% confidence interval (CI) was considered for the measurement. Intraclass Correlation Coefficient (ICC) values ​​>0.50 to 0.74 indicated moderate reliability; 0.75 to 0.90 indicated good reliability, and ICC values ​​>0.90 indicated excellent reliability. Finally, the absolute frequency information (p < 0.05) was obtained [31].

Results

Sample analysis

The mean age of the primiparous women in the study was 23.2 ± 2.26 years, whereas the mean age of the multiparous women was 27.8 ± 2.01 years. Concerning occupation, 76.3% of the participants identified themselves as housewives, 29% as informal vendors, and 2.6% as hairdressers. Regarding educational level, 76.3% did not complete basic education, and 37.7% completed basic education. Regarding maternity status, 73.6% were multiparous women, and 26.3% were primiparous women (Table 2).

Table 2.

Characteristics of the participants

Characteristics		Primiparous women (n = 20)	Multiparous (n = 56)
Age in years (Mean ± SD)		23.2 ± 2.26	27.8 ± 2.01
Weeks of gestation (Mean ± SD)		31.6 ± 2.84	33.6 ± 3.25
Schooling	Incomplete basic education	17.1% (13)	59.2% (45)
	Complete basic education	9.2% (7)	14.5% (11)
Job	Housewife	11.8% (9)	56.6% (43)
	Informal seller	13.2% (10)	15.8% (12)
	Hairdresser	1.3% (1)	1.3% (1)
Marital status	Paired	17.1% (13)	36.8% (28)
	Married	9.2% (7)	36.8% (28)

Source: Own elaboration

Descriptive analysis of the scale

A descriptive analysis was conducted on the 14 items in the breastfeeding self-efficacy questionnaire. The results indicate that participants perceived high self-efficacy regarding breastfeeding, with mean values ​​ranging from 4.21 to 4.74 on a scale of 1 to 5. The items with the highest means correspond to aspects of motivation and desire to breastfeed (e.g., “I can maintain the desire to breastfeed” with M = 4.74, SD = 0.50), while those related to potentially stressful situations, such as a crying child, obtained slightly lower scores (e.g., “I can handle the breastfeeding situation even if my child cries,” with M = 4.21, SD = 0.618). The standard deviations remained low for all items (between 0.47 and 0.68), demonstrating a homogeneity in the responses. Predominant negative skewness suggests that most participants scored toward the upper end of the scale, while slightly positive or negative kurtosis indicates distributions that are slightly more concentrated or flatter than a normal distribution. (Table 3).

Table 3.

Descriptive statistics of the scale by factor and in general

No.	Reagent	M	SD	Min	Max	Asymmetry	Kurtosis
1	I can determine that my child is getting enough milk from my breast.	4.68	0.47	4	5	-0.81	-1.38
2	I can successfully deal with breastfeeding just as I have dealt with other challenges in my life.	4.39	0.492	4	5	0.439	-1.856
3	I can breastfeed my child without using milk formulas.	4.61	0.544	3	5	-0.945	-0.156
4	I can ensure that my child is properly attached to my breast while feeding.	4.55	0.551	3	5	-0.704	-0.592
5	I can manage the breastfeeding situation for my well-being.	4.47	0.642	3	5	-0.829	-0.330
6	I can handle the breastfeeding situation even if my child is crying.	4.21	0.618	3	5	-0.162	-0.489
7	I can maintain the desire to breastfeed.	4.74	0.500	3	5	-1.735	2.244
8	I can breastfeed comfortably when my family members are present.	4.45	0.641	3	5	-0.735	-0.444
9	I can be satisfied with the breastfeeding experience.	4.61	0.634	3	5	-1.375	0.764
10	I can face the fact that breastfeeding will take up my time.	4.29	0.649	3	5	-0.366	-0.685
11	Can I finish breastfeeding my baby on one breast before switching to the other breast?	4.32	0.616	3	5	-0.312	-0.614
12	I can breastfeed my child whenever he needs it.	4.50	0.643	3	5	-0.928	-0.186
13	I can meet my child’s breastfeeding needs.	4.39	0.675	3	5	-0.674	-0.610
14	I can recognize when my child has finished breastfeeding.	4.45	0.598	3	5	-0.562	-0.581

Source: Own elaboration

Exploratory factor analysis

Exploratory factor analysis revealed that the KMO value was 0.853, and Bartlett’s spherical test statistic was 973.67 (p < 0.001). Both values ​​show that the correlation matrix is ​​suitable for EFA. The analysis obtained a total of two factors that explained 70.14% of the scale’s variance. Factor 1 had an eigenvalue of 8.13, and the second factor had an eigenvalue of 1.69, indicating adequate construct validity. The communalities of each item were evaluated, and for most items, an h2 value of > 0.5 was obtained, indicating a good fit of the item to the entire test. To determine the factor loadings of each item in each component, an Oblmin rotation was performed. The results of the factor loadings can be seen in Table 4.

Table 4.

Factor loads

Ítem	h2	Factor 1. Cognitive	Factor2. Functional
Ítem 1	0.764	0.871
Ítem 2	0.487	0.687
Ítem 3	0.832	0.912
Ítem 4	0.553	0.728
Ítem 5	0.839	0.907
Ítem 6	0.512		0.610
Ítem 7	0.573	0.757
Ítem 8	0.753		0.867
Ítem 9	0.789		0.863
Ítem 10	0.733		0.837
Ítem 11	0.727		0.798
Ítem 12	0.839		0.812
Ítem 13	0.779		0.843
Ítem 14	0.642		0.688

Source: Own elaboration

The scale consisted of two factors: cognitive, consisting of items 1, 2, 3, 4, 5, and 7, and behavioral, consisting of items 6 and 8–14. The entire scale showed adequate construct validity values, and the factors had a moderate correlation (r = 0.508).

Reliability analysis

In the reliability analysis, the Cronbach’s alpha for the self-efficacy scale in BF in the Haitian context was 0.943. The reliability test for the cognitive and functional factors produced Cronbach’s alpha values ​​of 0.901 and 0.931, respectively. The internal consistency measures carried out through the test-retest method, whose correlation index was 0.907, indicate a strong and statistically significant correlation, with p = 0.000 between both measures. The intraclass correlation analysis showed adequate reliability values ​​in the entire scale (0.94, 95% CI [0.922, 0.960]), as well as the cognitive (0.901, 95% CI [0.862, 0932]) and functional (0.931, 95% CI [0.905, 0.952]) factors.

When the scale was analyzed, the mean response for the total score was 62.65, SD = 6.29, reflecting lower variability in the responses of pregnant women. The asymmetry was − 0.66, which suggests a slight inclination to the left, and the kurtosis was − 0.76, which indicates that the participants’ responses on the entire scale tend to have a normal and mesokurtic distribution. When both factors were examined, factor 1 of cognition presented a mean value of 27.44, SD = 2.63, which indicates low variability in the cognitive perception of self-efficacy in BF. The asymmetry was − 0.78, which suggests a slight inclination to the left, and the kurtosis was − 0.61, which indicates a tendency to normal distribution and variability in the responses. This could be interpreted as a tendency for mothers to have higher scores in their cognitive confidence, that is, in their belief and knowledge about their ability to breastfeed. Concerning factor 2, functionality has a mean of 35.21, SD = 4.17 with skewness of -0.65 and kurtosis of -0.53. The asymmetry to the left and the negative kurtosis suggest that some responses are close to the maximum value, and few responses are in the lower range (Table 5).

Table 5.

Measures of factor distribution

Scale	Average	SD	Minimum	Maximum	Asymmetry	Kurtosis	Cronbach’s alpha
Factor 1. Cognitive	27.44	2.63	21	30	-0.78	-0.61	0.901
Factor 2. Functional	35.21	4.17	26	40	-0.65	-0.53	0.931
Total	62.65	6.29	48	70	-0.66	-0.76	0.943

Source: Own elaboration

Discussion

This research aimed to perform a cross-cultural adaptation and psychometric evaluation of the BSES-SF scale in Haitian Creole. The results of this study indicate that the BSBS-SF self-efficacy scale in LM, when translated into Haitian Creole is composed of 14 items, which have a structure of two dimensions or factors that explain 70.1% of the total variance of the instrument, which coincides with other studies of cross-cultural adaptation [22, 23]. It has reliability values of 0.901 and 0.906 in both dimensions and a Cronbach’s alpha of 0.943 on the global scale, so eliminating any item was unnecessary. These findings coincide with those of the original study [18]. Furthermore, these results suggest that the scale has adequate psychometric properties, so it can be used as a valid and reliable tool in Haitian women to evaluate their self-efficacy for BF, consistent with other studies with similar characteristics [29, 32].

The construct validity was carried out through principal component factor analysis, where two dimensions were extracted, the first oriented to the knowledge of the act of breastfeeding and the second to the functional ability to maintain BF, results that coincide with those reported by Boateng and collaborators [33]. On the other hand, studies that considered only one dimension were found and included mothers with children born at term, post-term, and premature [17, 23, 26, 34]. The studies that obtained only one dimension in the analysis of the survey are likely due to the inclusion of mothers with hospitalized children, who must bear the emotional burden that this situation produces, and in whom the risk of not breastfeeding increases due to the problem [23]. The unidimensionality may also be due to the different cultural contexts in which the scale has had to be adapted, since in Middle Eastern countries, women do not breastfeed in front of men, so in these regions, the original scale has been adapted, extracting the item of performing the act in front of the family [35].

Regarding the translation of the scale into Creole, the mean of the total result of the scale was 62.6 ± 6.26, which coincided with the total mean of the translation of the same scale into Portuguese, carried out by Zubarán et al. [36]. On the other hand, Amini et al., who translated the same scale into Persian, described a lower mean than that reported in the present study [32]. This difference could be explained because the population studied by Amini et al. corresponded mostly to primiparous mothers (57.7%), whereas in the present study, most of the participants were multiparous mothers (73.7%). In this context, it can be inferred that multiparity is a favorable variable in the duration of BF [34], and being a primiparous mother implies a deficit in self-efficacy in BF [37, 38].

The present study yielded high Cronbach’s alpha test results. These values were above the satisfactory threshold of 0.700 for the scale’s reliability [36], thus indicating low measurement error and consistency of the items in the measurement of the breastfeeding self-efficacy construct, so removing any item was unnecessary. This finding is similar to that reported in the original study of the BSES-SF [18] and comparable with other studies reporting psychometric data of this brief version of the scale [19, 22, 23, 33, 34, 38–42].

This study presents several strengths that highlight its relevance and rigor. First, the cross-cultural adaptation of the BSES-SF to Haitian Creole represents a significant contribution to the field of public health, as it addresses a critical gap in the assessment of self-efficacy in BF in migratory contexts. The psychometric validation process included rigorous measures, such as EFA, reliability tests using Cronbach’s alpha, and intraclass correlation, ensuring that the scale is a valid and reliable tool. Furthermore, the inclusive approach, which incorporates translators and BF experts, ensures that the instrument is culturally sensitive and relevant to the Haitian population in Chile.

However, this study also has limitations. A limitation of this study is the sample size, which does not allow for generalizations about the scale scores. From a psychometric perspective, limited sample sizes reduce the scale’s statistical power. However, to overcome this limitation, a sample selection process was carried out following statistical parameters that allowed for adequate validity and reliability values ​​ [25]. Thus, although the sample size is small, it does not compromise the validation results. Additionally, the sample obtained for this validation may include a large proportion of participants who meet the criteria for migratory status and pregnancy. That is, according to the Haitian migrant community in Chile [3], they represent 8.4% of the total number of migrants in the country. Considering that migrants from different countries around the world represent only 4.35% of the Chilean population, the number of pregnant migrant women of Haitian nationality may be limited. Therefore, the sample for this study may not be representative, considering the limited number of individuals who meet the validation criteria.

In terms of projections, this study opens several opportunities for future research. It is recommended to replicate the validation of the scale in other regions of Chile and rural contexts to assess its applicability and consistency in different environments. Likewise, longitudinal designs would allow exploration of how self-efficacy in BF evolves and how this influences exclusive breastfeeding rates. In addition, the findings can serve as a basis for designing and implementing interventions aimed at improving self-efficacy in BF in migrant communities, thus contributing to the achievement of public health goals related to breastfeeding. Finally, it would be relevant to compare the results of this scale with those of similar tools used in different cultural contexts to strengthen the external validity of the instrument.

Conclusion

This study performed a cross-cultural adaptation and psychometric evaluation of the BSES-SF scale in Haitian Creole. This cross-cultural adaptation demonstrated that the BSES-SF is a valid and reliable tool for measuring BF self-efficacy in Haitian women residing in Chile. This work not only responds to an urgent need for culturally adapted instruments but also strengthens the capacity of health systems to serve migrant populations more effectively. From a practical standpoint, the findings of this study suggest that the scale can be used to identify specific barriers to maternal confidence in breastfeeding and to guide tailored interventions that promote exclusive breastfeeding. Health professionals, such as midwives and nurses, could integrate the scale into educational and counseling programs, increasing breastfeeding rates in vulnerable communities. At the research level, this study establishes a solid foundation for future research on BF self-efficacy in multicultural contexts. Exploring how self-efficacy influences the duration and quality of breastfeeding in different migrant populations, as well as evaluating the effectiveness of interventions based on this scale, is recommended. Furthermore, extending the validation to other languages and cultures will broaden its global applicability and relevance.

Abbreviations

BF

Breastfeeding

BSES

Breastfeeding Self-Efficacy Scale

BSES-SF

Breastfeeding Self-Efficacy Scale-Short Form

EBF

Exclusive breastfeeding

LA

Latin America

MINSAL

Ministry of Health

SD

Standard deviation

WHO

World Health Organization

Author contributions

JN: diseño del trabajo; adquisición, análisis, interpretación de los datos; redacción del trabajo; revisión del trabajo. RF: diseño del trabajo; adquisición, redacción del trabajo; revisión del trabajo. MR: interpretación de los datos; redacción del trabajo; revisión del trabajo. ML: interpretación de los datos; redacción del trabajo; revisión del trabajo. PR: interpretación de los datos; redacción del trabajo; revisión del trabajo. JP: interpretación de los datos; redacción del trabajo; revisión del trabajo. SM: interpretación de los datos; redacción del trabajo; revisión del trabajo. JI: interpretación de los datos; redacción del trabajo; revisión del trabajo; diseño de tablas.

Funding

The research that led to these results was funded by the authors themselves.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Competing interests

The authors declare no competing interests.

Number of essay clinics

No applicable.