Identifying Breastfeeding Knowledge Gaps in Women with Gestational Diabetes

A methodological instrument-development and psychometric validation study in women with gestational diabetes mellitus (GDM) (n=220) produced a 14-item GDM-specific breastfeeding knowledge instrument that can be completed in a median of about 7 minutes, supporting rapid identification of knowledge gaps when counseling time is tight.

The investigators built an initial 30-item pool mapped to prespecified domains; it underwent expert review by six clinicians, experiential review by 10 women with GDM, linguistic review, and then field testing. Items were reduced stepwise from 30 to 24 to 19 to 14, consistent with trimming redundancy and removing weaker discriminators while protecting domain coverage. The resulting 14 items remain anchored in content-vetted, patient-informed areas relevant to GDM-specific breastfeeding counseling.

Psychometric testing supported factor analysis in this sample (Kaiser–Meyer–Olkin 0.884; significant Bartlett test), indicating sufficient inter-item correlation for structure exploration. The final three-factor solution explained 51.63% of variance and mapped to clinically interpretable domains: Benefits (9 items), Postpartum Physical Characteristics (3 items), and Barriers (2 items). Internal consistency was strong for a brief, dichotomous measure (KR-20 0.826), and convergent validity was moderate with an established breastfeeding knowledge scale (r≈0.43), suggesting the instrument captures a related but context-specific construct.

Operationally, the 14 dichotomous items score to a total of 0–14, allowing rapid scoring alongside routine documentation. Two reverse-coded items explicitly probe misconceptions—often the most actionable targets for brief counseling—without requiring narrative assessment.