Phase 2 assessing content validity
Eleven experts were asked for feedback about the tool. All experts had worked with breastfeeding mothers and babies, and eight experts were also researchers with published papers. The nine experts who responded represented Australia, Canada, Sweden, the United Kingdom, and the United States. There were recommendations to clarify language, to simplify the adminstration, and to reformat the chart. Response to the use of scores was mixed; some liked it, some did not, and others did not comment.
Phase 3 testing reliability
Seventy-five breastfeeding mothers were recruited for the study from the postpartum unit during three weeks in July and August 2012 (see Table 1 for participant characteristics). We did not record how many patients were approached by the nurses, but very few refused after the researcher or a research assistant explained the study. The main reason given for not joining the study was "too busy"
Ideally, to measure inter-rater reliability, we wanted the calls to be as close together as possible, but several factors made it difficult including availability of the second RA and availability of mother (e.g., if a participant left to shop or go on vacation after the first call or the second RA was in class or at work). We included all calls made within 48 hours of each other, even though the recall for one time point was past 24 hours. The second caller asked if there had been any significant change in the past 24 hours (e.g., separation between mother and baby or the start of supplements) but the majority of participants said no. These responses were verified, as evidenced by the high inter-rater reliability, and showed that mothers were staying consistent from one day to the next.