Contemporary Research Analysis Journal

Although breastfeeding is widely promoted as a public health ideal, many mothers experience intense social scrutiny regarding both their infant feeding practices and their bodies. This form of social pressure—often expressed through unsolicited advice, criticism, and body-related judgments—can undermine maternal psychological well-being, body image, and breastfeeding persistence, yet remains largely unmeasured in reproductive and infant psychology research. This study aimed to develop and psychometrically validate a psychosocial scale assessing perceived social pressure and criticism experienced by breastfeeding mothers.

Scale items were generated through focus group interviews with breastfeeding women to capture lived experiences of social judgment related to infant feeding and maternal body image. Content validity was established using expert review and the Lawshe method. Following pilot testing, the final 12-item scale was administered to 400 breastfeeding mothers. Construct validity was evaluated using exploratory and confirmatory factor analyses, and internal consistency was assessed using Cronbach’s alpha coefficients. Factor analyses supported a two-factor structure—Infant Feeding Pressure and Maternal Body Image Pressure—explaining 59% of the total variance. The model demonstrated good fit to the data (χ²/df = 2.96, RMSEA = 0.07, CFI = 0.95, NNFI = 0.97). Internal consistency was high for the total scale (α = 0.84) and for both subscales. The Breastfeeding-Related Social Pressure Scale is a reliable and valid instrument for assessing a largely overlooked psychosocial burden in breastfeeding mothers. By operationalising social pressure and body surveillance, this scale supports research on maternal well-being and infant feeding experiences.

Breastfeeding, social pressure, body image, maternal well-being, reproductive psychology, scale validation

1. Ayre, C., & Scally, A. J. (2014). Critical values for Lawshe’s content validity ratio: Revisiting the original methods of calculation. Measurement and Evaluation in Counseling and Development, 47(1), 79–86.
   https://doi.org/10.1177/0748175613513808
2. Blum, L., & Korner-Bitensky, N. (2008). Usefulness of the Berg Balance Scale in stroke rehabilitation: A systematic review. Physical Therapy, 88(5), 559–566. https://doi.org/10.2522/ptj.20070205
3. Boateng, G. O., Neilands, T. B., Frongillo, E. A., Melgar-Quiñonez, H. R., & Young, S. L. (2018). Best practices for developing and validating scales for health, social, and behavioral research: A primer. Frontiers in Public Health, 6, Article 149. https://doi.org/10.3389/fpubh.2018.00149
4. Bujang, M. A., Omar, E. D., & Baharum, N. A. (2018). A review on sample size determination for Cronbach’s alpha test: A simple guide for researchers. Malaysian Journal of Medical Sciences, 25(6), 85–99. https://doi.org/10.21315/mjms2018.25.6.9
5. Carpenter, S. (2018). Ten steps in scale development and reporting: A guide for researchers. Communication Methods and Measures, 12(1), 25–44. https://doi.org/10.1080/19312458.2017.1396583
6. Çiftçi, B., Yıldız, G. N., & Yıldız, Ö. (2023). Hospital-acquired insomnia scale: A validity and reliability study. World Journal of Psychiatry, 13(3), 113–125. https://doi.org/10.5498/wjp.v13.i3.113
7. DeVellis, R. F. (2022). Scale development: Theory and applications (3rd ed., T. Totan, Trans.). Nobel Akademik.
8. Diez-Sampedro, A., Flowers, M., Olenick, M., Maltseva, T., & Valdes, G. (2019). Women’s choice regarding breastfeeding and its effect on well-being. Nursing for Women’s Health, 23(5), 383–389. https://doi.org/10.1016/j.nwh.2019.07.004
9. Gao, Y., Cui, M., Yang, C., Wu, Y., Long, Y., Chen, Y., Liu, H., Sun, L., Yang, Y., & Li, X. (2020). Validity and reliability of the Brain Health Self-Efficacy Scale for the elderly. General Psychiatry, 33(5), e100208. https://doi.org/10.1136/gpsych-2020-100208
10. Ghardallou, M., Zedini, C., Sahli, J., Ajmi, T., Khairi, H., & Mtiraoui, A. (2022). Psychometric properties of a French version of the Jefferson Scale of Empathy. International Journal of Medical Education, 13, 205–214. https://doi.org/10.5116/ijme.62d2.8497
11. Gulati, T., & Shankar, S. (2025). Measuring an extended view of corporate citizenship: Manifestations drawn from scale development, refinement, and validation. Quality & Quantity, 59, 3869–3897. https://doi.org/10.1007/s11135-024-01926-2
12. Harerimana, A., & Mtshali, N. G. (2020). Using exploratory and confirmatory factor analysis to understand the role of technology in nursing education. Nurse Education Today, 92, 104490. https://doi.org/10.1016/j.nedt.2020.104490
13. Howard, M. C. (2016). A review of exploratory factor analysis decisions and overview of current practices. International Journal of Human–Computer Interaction, 32(1), 51–62. https://doi.org/10.1080/10447318.2015.1087664
14. Hunt, L., & Thomson, G. (2017). Pressure and judgement within a dichotomous landscape of infant feeding: A grounded theory study. Maternal & Child Nutrition, 13(2), e12279. https://doi.org/10.1111/mcn.12279
15. Hvatum, I., & Glavin, K. (2017). Mothers’ experience of not breastfeeding in a breastfeeding culture. Journal of Clinical Nursing, 26, 3144–3155. https://doi.org/10.1111/jocn.13655
16. Jenkins, D. (2020). Comparing dichotomous and polytomous items using item response trees. Educational and Psychological Measurement, 80(2), 358–382. https://doi.org/10.1177/0013164419877390
17. Korth, C. X., Keim, S. A., Crerand, C. E., & Jackson, J. L. (2022). New mothers’ perceptions of pressure to breastfeed. MCN: The American Journal of Maternal/Child Nursing, 47(3), 160–167. https://doi.org/10.1097/NMC.0000000000000814
18. Lawshe, C. H. (1975). A quantitative approach to content validity. Personnel Psychology, 28(4), 563–575.
19. Nkansah, B. (2018). On the Kaiser–Meyer–Olkin measure of sampling adequacy. Mathematical Theory and Modeling, 8, 52–76.
20. O’Brien, M., Buikstra, E., & Hegney, D. (2008). The influence of psychological factors on breastfeeding duration. Journal of Advanced Nursing, 63(4), 397–408. https://doi.org/10.1111/j.1365-2648.2008.04722.x
21. Özdamar, K. (2016). Ölçek ve test geliştirme: Yapısal eşitlik modellemesi. Nisan Kitabevi.
22. Pinto-Carral, A., Fernández-Villa, T., Guccione, A. A., Cuadrado, F. M., Cancela, J. M., & Molina, A. J. (2019). Validity, reliability, and responsiveness of the Spanish version of the OPTIMAL instrument. PM&R, 11(3), 258–269. https://doi.org/10.1016/j.pmrj.2018.05.021
23. Rollins, N. C., Bhandari, N., Hajeebhoy, N., Horton, S., Lutter, C. K., Martines, J. C., Piwoz, E. G., Richter, L. M., & Victora, C. G. (2016). Why invest, and what it will take to improve breastfeeding practices. The Lancet, 387(10017), 491–504. https://doi.org/10.1016/S0140-6736(15)01044-2
24. Roll, C. L., & Cheater, F. (2016). Expectant parents’ views of factors influencing infant feeding decisions. International Journal of Nursing Studies, 60, 145–155. https://doi.org/10.1016/j.ijnurstu.2016.04.011
25. Seong, M., Park, J., Chung, S., & Sok, S. (2021). Development of the Adult Pandemic Attitude Scale (A-PAS). International Journal of Environmental Research and Public Health, 18(12), 6311. https://doi.org/10.3390/ijerph18126311
26. Shiraishi, M., Matsuzaki, M., Kurihara, S., Iwamoto, M., & Shimada, M. (2020). Post-breastfeeding stress response and breastfeeding self-efficacy. BMC Pregnancy and Childbirth, 20, Article 730. https://doi.org/10.1186/s12884-020-03416-5
27. Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53–55. https://doi.org/10.5116/ijme.4dfb.8dfd
28. Thomson, G., Ebisch-Burton, K., & Flacking, R. (2015). Shame if you do—shame if you don’t. Maternal & Child Nutrition, 11(1), 33–46. https://doi.org/10.1111/mcn.1214
29. Thompson, K. A., White, J. P., & Bardone-Cone, A. M. (2023). Associations between pressure to breastfeed and mental health symptoms. Psychiatry Research, 328, 115432. https://doi.org/10.1016/j.psychres.2023.115432
30. United Nations Children’s Fund. (n.d.). Breastfeeding. https://data.unicef.org/topic/nutrition/breastfeeding/
31. World Health Organization. (2023). Infant and young child feeding. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding
32. Zijlmans, E. A. O., Tijmstra, J., van der Ark, L. A., & Sijtsma, K. (2019). Item-score reliability as a selection tool in test construction. Frontiers in Psychology, 9, Article 2298. https://doi.org/10.3389/fpsyg.2018.02298