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A recent COSMIN review evaluates the effectiveness of various breastfeeding measurement instruments to standardize clinical assessments. Researchers analyzed 54 studies covering 24 tools to determine their psychometric quality. Despite the variety of options, clinicians often face challenges due to inconsistent findings. This review addresses those challenges by providing a validated evidence base for instrument selection.
Consequently, the study identified seven tools that meet the highest quality standards. These Grade A recommendations include tools for measuring self-efficacy, support needs, and behavior prediction. Moreover, using these breastfeeding measurement instruments can help healthcare providers improve maternal support strategies. Clinicians can now select tools with higher confidence in their psychometric stability.
However, the review also highlights significant evidence gaps in many existing tools. For instance, reliability data were missing for over half of the instruments evaluated. Additionally, fewer than 30% of studies assessed cross-cultural validity or measurement invariance. Furthermore, no instrument has established values for minimal important change or smallest detectable change. Therefore, future research must prioritize closing these critical gaps to enhance clinical utility. Clinicians should focus on using tools with the strongest evidence for reliability and validity.
Seven instruments focusing on maternal self-efficacy, support needs, and breastfeeding behavior prediction received Grade A recommendations for their strong psychometric evidence.
Many tools lack data on reliability, cross-cultural validity, and clinically meaningful change parameters. Future validation research is needed to establish these essential metrics for all recommended tools.
Disclaimer: This content is for informational and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.
References
Liu B et al. Breastfeeding Measurement Instruments: A COSMIN Review and Recommendation. J Hum Lact. 2026 Mar 22. doi: 10.1177/08903344261420017. PMID: 41865309.
Sartorio BT et al. Breastfeeding assessment instruments and their use in clinical practice. Rev Gaucha Enferm. 2017;38(1):e64675. doi: 10.1590/1983-1447.2017.01.64675.
Elsman EBM et al. Guideline for reporting systematic reviews of outcome measurement instruments (OMIs): PRISMA-COSMIN for OMIs 2024. J Clin Epidemiol. 2024. doi: 10.1016/j.jclinepi.2024.111422.
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