Validation of the Early Feeding Skills Assessment Scale for the Evaluation of Oral Feeding in Premature Infants

Document Type: Original Article


1 Student Research Committee, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences , Isfahan , Iran

2 Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

3 Community Medicine Department, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Pediatrics, Division of Neonatology, Child Growth and Development Research center, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Feeding difficulties are common and important in premature infants. In order to identify neonatal feeding difficulties, clinicians and nurses require assessment tools to conduct an objective evaluation of infant oral feeding (breast/bottle-feeding). Early identification of infants with feeding difficulty is critical to implement appropriate therapies and optimize the infant’s nutrition and oral feeding skill development. The aim of this study was to validate the Early Feeding Skills (EFS) Instrument for the Evaluation of Oral Feeding in Premature Infants.
Methods: In this descriptive cross-sectional study, the researcher initially got permission from the designer of the tool through email. Then, the main version of this tool was translated into Persian using the standard backward/forward method. Subsequently, the formal and content validity of the questionnaire was confirmed. After visiting a neonatal specialist, the assessment of preterm infants' oral feeding skills was performed using the EFS Instrument by observing the infants (n=180) during feeding. The exploratory factor analysis and Cronbach’s alpha were utilized to determine the construct validity and assess the reliability of the instrument, respectively.
Results: All items of the EFS Instrument had formal validity. Two items were removed from the instrument, based on content validity. On the basis of factor analysis, the items with a minimum factor load of 0.4 were evaluated and according to the factor load of all items (above 0.4), EFS Instrument had the appropriate construct validity. The Cronbach's coefficient of the instrument was obtained 0.88.
Conclusion: The EFS Instrument obtained the required reliability and validity for the evaluation of preterm infants oral feeding.


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