Development and Interrater Reliability of the Lactation Assessment Care Tool

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Abstract
Background: There have been no comprehensive predictive measurement instruments published that account for the dynamic interaction between maternal, infant, and functional factors related to breastfeeding difficulty. The Lactation Care Assessment Tool (LACT) was developed by the authors as a predictive measure of lactation acuity to identify families at risk for breastfeeding difficulty and facilitate access to the most effective level of care. Research Aim: To describe the development, content validation, and interrater reliability of the LACT. Methods: This study was a cross-sectional, online survey. Upon reading a standardized case scenario reflective of common experiences among families with goals to breastfeed, participants ( N = 82) anonymously completed the LACT, which consisted of 16 measures based upon research relevant to maternal, infant, and functional factors affecting breastfeeding success. Descriptive statistics were used to summarize and describe the characteristics of the study sample. Interrater reliability was evaluated using Krippendorff’s alpha. Results: An acceptable degree of interrater reliability ( α = 0.70) among participants was detected for the 16 measures included in the instrument. Conclusion: This instrument supports Baby-Friendly Hospital Initiative Step 10 to facilitate more precise and timely continuity of care after discharge from the hospital by identifying families in need of referral to a level of care consistent with their lactation acuity. Future research is necessary to determine appropriate levels of care and support based on the instrument scores in diverse breastfeeding dyads during early lactation and through the duration of breastfeeding.

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