Psychometric Evaluation of 5- and 4-Item Versions of the LATCH Breastfeeding Assessment Tool during the Initial Postpartum Period among a Multiethnic Population

OBJECTIVES The aim of this study was to evaluate the internal consistency, structural validity, sensitivity and specificity of the 5- and 4-item versions of the LATCH assessment tool among a multiethnic population in Singapore. METHODS The study was a secondary analysis of a subset of data (n = 907) from our previous breastfeeding survey from 2013 to 2014. The internal consistency of the LATCH was examined using Cronbach's alpha. The structural validity was assessed using an exploratory factor analysis (EFA), and the proposed factors were confirmed by confirmatory factor analysis (CFA) using separate samples. Receiver operating characteristic analysis was used to evaluate the sensitivity and specificity of the LATCH score thresholds for predicting non-exclusive breastfeeding. RESULTS The Cronbach's alpha values of the 5- and 4-item LATCH assessments were 0.70 and 0.74, respectively. The EFA demonstrated a one-factor structure for the 5- and 4-item LATCH assessments among a randomized split of 334 vaginally delivered women. Two CFA of the 4-item LATCH demonstrated better fit indices of the models compared to the two CFA of the 5-item LATCH among another randomized split of 335 vaginally delivered women and 238 cesarean delivered women. Using cutoffs of 5.5 and 3.5 were recommended when predicting non-exclusive breastfeeding for 5- and 4-item versions of the LATCH assessment among vaginally delivered women (n = 669), with satisfactory sensitivities (94% and 95%), low specificities (0% and 2%), low positive predictive values (25%) and negative predictive values (20% and 47%). A cutoff of 5.5 was recommended to predict non-exclusive breastfeeding for 5- and 4-item versions among cesarean delivered women (n = 238) with satisfactory sensitivities (93% and 98%), low specificities (4% and 9%), low positive predictive values (41%) and negative predictive values (65% and 75%). Therefore, the tool has good sensitivity but poor specificity, positive and negative predictive values. CONCLUSIONS We found that the 4-item version demonstrated sound psychometric properties compared to the 5-item version. Health professionals can use the 4-item LATCH as a clinical tool because it is a concise, easy-to-use and valid tool for assessing breastfeeding techniques among a multiethnic population.