Table 5.

Overview of Research Studies Using Knowledge and Attitudes Tool.

Tool (Citation)	Study Author (Year)	Purpose	Location	Results	Method of Adaptation, Translation, Cross-Cultural Equivalency, or Pretesting
Australian Breastfeeding Knowledge and Attitude Questionnaire (Brodribb, Fallon, Jackson, & Hegney, 2008)	Srinivasan, Graves, & D’Souza (2014)	“To test the effectiveness of a 3-hour course on breastfeeding for family physicians”	Canada	Not discussed	“A modified version of the validated Australian Breastfeeding Knowledge and Attitude Questionnaire was used,” although the nature of modification was not discussed.
Iowa Infant Feeding Attitude Scale (de la Mora, Russell, Dungy, Losch, & Dusdieker, 1999)	Charafeddine et al. (2015)	To assess the “psychometric properties of the Arabic version of the IIFAS (IIFAS-A)”	Beirut, Lebanon	Cronbach’s alpha = 0.640	“After translating to classical Arabic and back-translating to English, the IIFAS-A was pilot tested among 20 women for comprehension, clarity, length, and cultural appropriateness.”
	Srinivas, Benson, Worley, & Schulte (2015)	“To study the interaction of breastfeeding attitude and self-efficacy with the intervention,” aiming “to improve rates of any and exclusive breastfeeding at 1 and 6 months using a low-intensity peer counseling intervention beginning prenatally”	Cleveland, Ohio, United States	Not discussed	Used in original format
	Tuthill et al. (2016)	To construct a “consolidated instrument [that] was adapted to be culturally relevant and translated to yield more reliable and valid results for use in our larger research study to measure infant feeding determinants effectively in our target cultural context”	KwaZulu-Natal, South Africa	Cronbach’s alpha = 0.79-0.86	The IIFAS was combined with other instruments to make one consolidated instrument, which was then “cross-culturally adapted utilizing a multi-step approach.”
	Twells et al. (2014)	“To assess the reliability and validity of the IIFAS in expectant mothers; to compare attitudes to infant feeding in urban and rural areas; and to examine whether attitudes are associated with intent to breastfeed”	Newfoundland and Labrador, Canada	Cronbach’s alpha = 0.80	Used in original format
	Van Wagenen, Magnusson, & Neiger (2015)	To collect information on “U.S. men’s knowledge of and attitudes towards breastfeeding” in the context of social support	United States	Cronbach’s alpha = 0.78	Used in original format
Preterm Infant Feeding Survey (Dowling, Madigan, Anthony, Elfettoh, & Graham, 2009)	Dowling, Shapiro, Burant, & Elfettoh (2009)	“To examine the factors involved in mothers’ decisions to provide breast milk for their premature infants and to determine if these factors differ between Black and White mothers”	Eastern United States	Cronbach’s alpha = 0.84	Used in original format
	Dowling, Blatz, & Graham (2012)	“Examined differences in outcomes of provision of mothers’ milk before and after implementation of a single-family room (SFR) neonatal intensive care unit (NICU) and described issues related to long-term milk expression”	Ohio, United States	Cronbach’s alpha = 0.73-0.85	Used in original format
Breast Milk Expression Experience (Flaherman et al., 2013)	Flaherman et al. (2011)	“To compare bilateral electric breast pumping to hand expression among mothers of healthy term infants feeding poorly at 12–36 h after birth”	California, United States	Not discussed	Used in original format
Breast-feeding Attrition Prediction Tool (BAPT) (Janke, 1992)	Gill, Reifsnider, Lucke, & Mann (2007)	“To describe a revised BAPT, administered antepartally, that measures intention to breastfeed”	Southwestern United States	Cronbach’s alpha = 0.78-0.86	“Was translated into Spanish and back-translated for accuracy. The BAPT was then revised by reducing the number of items to 35 (32 were used for analysis) and contracting the 6-point scale to 3 categories”
	Joshi, Trout, Aguirre, & Wilhelm (2014)	“To explore factors that influence breastfeeding initiation and continuation among Hispanic women living in rural settings” and “to develop a framework for an educational breastfeeding program to meet the needs of Hispanic women living in rural settings”	Nebraska, United States	Not discussed	Nature of revisions not discussed
	Kafulafula, Hutchinson, Gennaro, Guttmacher, & Kumitawa (2013)	“To determine factors that influence HIV-positive mothers’ prenatal intended duration of exclusive breastfeeding and their likelihood to exclusively breastfeed for 6 months”	Malawi	Cronbach’s alpha = 0.858	A modified form of the instrument called the Exclusive Breast-feeding Attrition Prediction Tool was developed.
	Lewallen et al. (2006)	To create an adaptation of the BAPT with the same purpose of identifying women at risk for premature weaning based on breastfeeding attitudes, with the additional purpose of making the instrument easier to administer and score	North Carolina, United States	Cronbach’s alpha = 0.85	The 5-point Likert-type scale of the BAPT was modified to a dichotomous response format.
	Wambach et al. (2011)	“To test the hypotheses that education and counseling interventions provided by a lactation consultant-peer counselor team would increase breastfeeding initiation and duration up to 6 months postpartum, when compared to control conditions. We also explored the effects of the intervention on exclusive breastfeeding rates.”	Midwestern United States	Cronbach’s alpha = 0.87-0.93	Used in original format
Breastfeeding Knowledge, Attitude, and Confidence Scale (Laanterä, Pietilä, & Pölkki, 2010)	Laanterä, Pölkki, Ekström, & Pietilä (2010)	“To describe Finnish parents’ prenatal breastfeeding attitudes and their relationships with demographic characteristics”	Southeastern Finland	Cronbach’s alpha = 0.602-0.858	“Five breastfeeding experts evaluated the scale and no changes were made to the attitude items on the basis of their evaluations. The pretest was performed in February 2009. Minor changes such as alterations to the wording were made to the scale on the basis of the pretest.”
Breastfeeding Behavior Questionnaire (Libbus, 1992)	Libbus (2000)	To examine “attitudes toward breastfeeding in 57 Spanish-speaking Hispanic American women”	Midwestern United States	A test-retest reliability was reported as a correlational coefficient = .96	Translated into Spanish, with content validity determined by Spanish-speaking health professionals
	Libbus & Kolostov (1994)	“Investigated attitudes regarding breastfeeding in 69 low-income women presenting for prenatal care at a teaching facility in a small Midwest United States community”	Midwestern United States	A test-retest reliability was reported as a correlational coefficient = .88	Used in original format
	Marrone, Vogeltanz-Holm, & Holm (2008)	“To examine university undergraduate women’s and men’s attitudes and knowledge toward breastfeeding”	North Dakota, United States	A test-retest reliability was reported, r = .88	Used in original format
	Nabulsi et al. (2014)	“To investigate whether a complex intervention targeting new mothers’ breastfeeding knowledge, skills and social support within a Social Network and Social Support theory framework will increase exclusive breastfeeding duration among women in Lebanon”	Lebanon	Not discussed	The questionnaire used in the study was adapted from the Breastfeeding Behavior Questionnaire among others and then translated into Arabic and back-translated to English.