BACKGROUND Validated instruments to assess breastfeeding knowledge and attitude are non-existent in Africa including Ethiopia. We aimed to adapt and validate the Breastfeeding Knowledge Questionnaire (BFKQ) and the Iowa Infant Feeding Attitude Scale (IIFAS) for use in Afan Oromo (AO), the most widely spoken language in Ethiopia. METHODS After forward-backward translation into Afan Oromo, the instruments were reviewed for content validity by a panel of a nutritionist and pediatricians, and pretested on a sample of 30 mothers. Then, a cross-sectional study involving 468 pregnant women in their second and third trimester was conducted between May and August 2017 in the Manna district, Southwest Ethiopia, using the final versions of the adapted questionnaires. We used exploratory and confirmatory factor analysis to assess the construct validity, receiver operating characteristic (ROC) curves to determine the predictive validity and Cronbach's alpha coefficients to assess internal consistency. RESULTS Using exploratory factor analysis (EFA), nine domains containing 34 items were extracted from the BFKQ-AO. A confirmatory factor analysis of the constructs from EFA confirmed construct validity of the instrument (χ2/df = 2.11, RMSEA = 0.049, CFI = 0.845, TLI = 0.823). In factor analysis of the IIFAS, the first factor explained 19.7% of the total variance and the factor loadings and scree plot test suggested unidimensionality of the tool. Cronbach's alpha was 0.79 for the BFKQ-AO and 0.72 for IIFAS-AO suggesting an acceptable internal consistency of both instruments. For the sensitivity and specificity in predicting intention of breastfeeding for ≥24 months, the area under the curve (AUC) was 82% for IIFAS score and 79% for BFKQ score. CONCLUSIONS Here we present the first study that reported the use of the BFKQ and the IIFAS in Ethiopia. Our results showed that both BFKQ-AO and IIFAS-AO can be reliable and valid tools for measuring maternal breastfeeding knowledge and attitude in the study population, showing the potential for adapting these tools for application in a wider Ethiopian context.

中文翻译：

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爱荷华州婴儿喂养态度量表和母乳喂养知识问卷的改编和验证，用于埃塞俄比亚。

背景技术在包括埃塞俄比亚在内的非洲，没有评估母乳喂养知识和态度的有效手段。我们旨在调整和验证母乳喂养知识问卷（BFKQ）和爱荷华州婴儿喂养态度量表（IIFAS），以用于埃塞俄比亚最广泛使用的语言Afan Oromo（AO）。方法在向后翻译成Afan Oromo之后，由营养学家和儿科医生组成的小组对仪器的内容有效性进行了审查，并对30名母亲进行了预先测试。然后，于2017年5月至8月之间在埃塞俄比亚西南部的Manna地区进行了横断面研究，涉及468名孕妇的中，晚期，使用了改编问卷的最终版本。我们使用探索性和验证性因素分析来评估构建体的有效性，接收器工作特性（ROC）曲线确定预测效度，克朗巴赫（Cronbach）α系数评估内部一致性。结果使用探索性因子分析（EFA），从BFKQ-AO中提取了包含34个项目的9个域。来自EFA的构建体的验证性因素分析证实了该仪器的构建体有效性（χ2/ df = 2.11，RMSEA = 0.049，CFI = 0.845，TLI = 0.823）。在IIFAS的因子分析中，第一个因子解释了总方差的19.7％，并且因子加载和卵石图测试表明该工具具有一维性。BFKQ-AO的Cronbachα为0.79，IIFAS-AO的Cronbachα为0.72，表明两种仪器的内部一致性都可以接受。为了预测≥24个月母乳喂养的意图的敏感性和特异性，IIFAS得分的曲线下面积（AUC）为82％，BFKQ得分的曲线下面积（AUC）为79％。结论在这里，我们提出了第一个报道埃塞俄比亚使用BFKQ和IIFAS的研究。我们的结果表明，BFKQ-AO和IIFAS-AO均可作为可靠且有效的工具来衡量研究人群中的母乳喂养知识和态度，显示出将这些工具应用于更广泛的埃塞俄比亚环境的潜力。