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Two-Year Test-Retest Reliability of the Breastfeeding Duration Question Used By the Pregnancy Risk Assessment Monitoring System (PRAMS): Implications for Research

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Abstract

Introduction

A large literature exists on positive sequelae of breastfeeding, relying heavily on maternal self-reported infant feeding behaviors. Many such studies use PRAMS data, though estimates of reliability for the breastfeeding duration question on PRAMS have not been published.

Methods

We used data from Oregon PRAMS (respondents are a median 3.5 months postpartum) and PRAMS-2 (median 25 months) to assess test-retest reliability of maternal self-reported breastfeeding duration, among women who had weaned prior to completing the PRAMS survey.

Results

The sample-wide kappa for the paired, self-reported breastfeeding duration was 0.014, and the intraclass correlation coefficient was 0.17, both of which indicate poor agreement. More than 80% of women reported a longer duration on PRAMS-2; the median (interquartile range) difference was +1.0 (0.31 – 2.1) months.

Discussion

Recent literature on this topic from high-income countries falls into two categories: entirely retrospective versus “prospective” reliability assessments. Entirely retrospective assessments (both inquiries occur well after weaning) universally report exceedingly high reliability, whereas “prospective” assessments (women report infant feeding behavior during infancy, immediately after weaning, and some years later are asked to replicate their original answer) universally report poorer reliability. Interestingly, all “prospective” reliability studies, including ours, found that women over-report past breastfeeding durations by about 1 month upon the second inquiry. Researchers need not refrain from using maternal self-reported breastfeeding durations, because participants are largely still ranked correctly, relative to each other. However, such research efforts must avoid attempting to determine any optimal threshold duration.

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Acknowledgements

The Oregon PRAMS and PRAMS-2 surveys are funded by the Centers for Disease Control and Prevention, the Health Resources and Services Administration (Maternal and Child Health Bureau), and the Oregon Public Health Division. Dr. Bovbjerg’s time was partially funded by the J. William Fulbright Scholarship Board and the Fulbright Commission in Ireland.

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Authors and Affiliations

  1. Epidemiology Program, College of Public Health and Human Sciences, Oregon State University, 103 Milam Hall, Corvallis, OR, 97331, USA

    Marit L. Bovbjerg

  2. Department of Obstetrics and Gynecology, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA

    Adrienne E. Uphoff

  3. Oregon Health and Science University-Portland State University School of Public Health, Portland, OR, USA

    Kenneth D. Rosenberg

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  1. Marit L. Bovbjerg
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  2. Adrienne E. Uphoff
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  3. Kenneth D. Rosenberg
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Correspondence to Marit L. Bovbjerg.

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Bovbjerg, M.L., Uphoff, A.E. & Rosenberg, K.D. Two-Year Test-Retest Reliability of the Breastfeeding Duration Question Used By the Pregnancy Risk Assessment Monitoring System (PRAMS): Implications for Research. Matern Child Health J 25, 1126–1135 (2021). https://doi.org/10.1007/s10995-021-03145-z

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