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. 2025 Aug 23;15(1):31028.
doi: 10.1038/s41598-025-15342-9.

Adaptation and validation of the Indonesian version of the early feeding skill assessment tool for low birth weight infants

Suni Hariati  1 , Erfina Erfina  2 , Andi Dwi Bahagia Febriani  3 , Ema Alasiry  3 , Asriaty Asriaty  4 , Haerani Haerani  5
Affiliations

Adaptation and validation of the Indonesian version of the early feeding skill assessment tool for low birth weight infants

Suni Hariati et al. Sci Rep. .

Abstract

Initiating oral feeding at inappropriate times can cause stress and complications for Low Birth Weight (LBW) infants. It is essential to assess the infant's readiness for oral feeding to minimize stress and support the transition to full oral feeding. An objective assessment tool is necessary to improve the accuracy of determining the right time to start oral feedings. This study aimed to translate, adapt, and psychometrically validate the original English version of the Early Feeding Skill Assessment Tool (EFS) into the Indonesian language. The EFS questionnaire, an observation instrument with 19 items, uses a 3-option scoring structure: not yet evident, emerging, or consistently observed. The following EFS adaptation phases: (1) forward translation; (2) synthesis of forward translation; (3) back translation; (4) harmonization of the original and back translation; (4) pre-testing with the expert committee for content and relevance; (5) pre-testing with target user population for clarity; and (6) field testing. The translation was carried out by a certified translator in conjunction with a bilingual health professional. Seven neonatal experts participated in the pre-testing phase, while six nurses engaged with the target population for further evaluation. A total of 128 observations were conducted on infants exhibiting stable hemodynamics during the field testing phase. The two forward translations differed in 12 items, leading to expert discussions and consensus on the translation. The pre-testing among seven expert for content validity showed The EFS I-CVI and S-CVI/ave were 1 for all questions, indicating full expert agreement. The pre-testing among six nurses for face validity showed clear instructions (93%), with question agreement ranging from 60 to 100%. Six items had < 80% agreement and were rewritten as suggest from nurses. In field testing from 128 observations among 52 LBW infants revealed 19 items were valid and their reliability was 0.918. The 19-item EFS Indonesian version is valid and reliable for LBW infants. It can be used to implement as an assessment for a common language for infant feeding skills among interprofessional teams, contributing to infant feeding success.

Keywords: Feeding behavior; Instruments; Low birth weight; Premature infants; Psychometrics.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics approval: The study received approval from the Ethical Review Board of the Faculty of Nursing at Hasanuddin University in Indonesia (No.691/UN4.18.3/TP.01.02/2024). All participants gave written informed consent before the data collection began. Enumerators collected all questionnaires anonymously. The data is securely stored and will only be used for research purposes.

Figures

Fig. 1
Fig. 1
The original EFS adaptation process to Indonesian version.
See this image and copyright information in PMC

References

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