Factors Affecting Thai Fathers’ Self-Efficacy to Support Exclusive Breastfeeding

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

General comments

Although the paper is well-written, it has major shortcomings that do not allow this study to offer rigorous analyses of the topic under study and subsequently to provide significant contributions to the literature.

First, it is stated that the paper is following the self-efficacy theory as conceptual framework. However, there are no variables included in the data collection and analysis that reflect the concepts included in this theory such as mastery experiences or social persuasion.

There is also no explanation of how the Thai version of the father’s self-efficacy scale provides a cultural adaptation – was this scale just a language translation? If so, how do you integrate the cultural component into your study? Are you not considering unique Thai practices/beliefs in breastfeeding and/or infant care?

Another major shortcoming is the statistical analysis. Specific research questions and their corresponding hypotheses are not provided. Thus, it is not clear what would be the most appropriate statistical analyses to answer research questions. As will be mentioned below, the type of analysis chosen does not seem to be the most adequate since it does not allow the reader to understand how all the demographic data was integrated into the analysis. Someone familiar with stepwise linear regression analysis will infer that the software looked for and kept only the variables that were found significant; however, for someone that does not know about regression, the variables just seem to disappear. Most importantly, this type of analysis takes away the ability of the authors to examine interesting and valuable research questions about their topic – Why did the authors choose to collect the demographic data that was collected in the first place? Are there any specific hypotheses you had about the relationships between participants’ characteristics and self-efficacy? I strongly suggest a justification for your chosen statistical technique and a more detailed description of what this analysis does OR the application of another regression technique such as hierarchical regression (again, this would depend on your specific research questions...Do you have any prior hypothesis on the relative importance of your variables? Do you wish to control for any factors?).

 Introduction

Strong introduction of the topic, including an excellent rationale for studying the concept of self-efficacy within the cultural context of Thailand families. However, the introduction can be improved by providing a more detailed description of the self-efficacy theory that is described as providing the conceptual framework in the paper. Minor edits are also suggested for clarify.

Line 39. There is no reference #4.

Line 44. Delete the extra space after ‘feeding.’

Line 46. Correct the reference from 8] to [8].

Lines 55-56. Rephase for clarity.

Lines 71-73. Rephase for clarity.

Lines 105-110. I suggest you provide operational definitions for the the concepts of ‘postpartum period’ and ‘antenatal period’ for readers unfamiliar with these stages.

Materials and Methods

Line 144. Delete extra space.

Line 145. ‘Participants’ should be in lower case, or the previous comma must be a period.

Lines 150-153. Provide more information on your power analysis. What kind of statistical analysis did you plan for? What are those 8 predictors?

Lines 176, 186-188, 200. Cronbach’s alpha is a measure of internal consistency not reliability.

Lines 240-241. Can you please elaborate on your statement? What are the strengths of a stepwise linear regression against other types of regression models? It is of my opinion that stepwise linear regression is not the best option unless your analysis is exploratory in nature. However, based on your literature review, this topic has been studied in the past and thus it is already known what variables are associated with fathers’ self-efficacy.

Results

Table 1. Correct alignment under ‘number of children’ and extra space in the title of the table.

How did you exactly define ‘nuclear’ vs ‘extended’? How was it coded in your analysis? Which family members count as ‘extended’ family? Are these family members temporarily in the household or permanently? – all this has implications in the interpretation of your results.

Comments on the Quality of English Language

Minor edits throughout the paper. 

Author Response

Please see uploaded file

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors.

Congratulations, your manuscript is very interesting and I hope will be read and cited. It is good to give attention to fathers and I am happy you did that.

The topis is original and relevant. the topic is original and important. It allows the inclusion of fathers in the broader process of lactation and breastfeeding and allows us to understand the important factors that can be a source of support for nursing mothers in their relationship with the child's father.

It could be mixed with a qualitative study. In my opinion control group could be potentially difficult to find but it could cover partners' of pregnant / postpartum women declaring the will of formula feeding.

I would like to suggest:

1. Please, verify whole manuscript towards minor spell mistakes (eg line 43, 45)

2. To replace a whole paragraph from line 77 to line 90 from Introduction to the discussion section.

3. I would like to ask you to clearly inform how many participants you surveyed - for me was hard to find it unambiguously in the Materials and Methods section.

4. I suggested to add two references, from my perspective, as a midwife and breastfeeding consultant:

Plagens-Rotman, K., Kubiak, S., Pięta, B., et al (2014). Material awareness on natural feeding. Ann Agric Environ Med., 21(2), 440-444. https://doi.org/10.5604/1232-1966.1108621  

Wszołek, K.M., Chmaj-Wierzchowska, K., Pięt, M. et al. Neonatal breast-suckling skills in the context of lactation and peripartum hormonal changes and additional factors—a pilot study. Int Breastfeed J 17, 66 (2022). https://doi.org/10.1186/s13006-022-00508-2

5. Table 2

- Extended Family

-3.07 1.09

-2.80 0.01*

-5.24

- -.91

- this is not clear

Table 1. - there is a shift in the children number.

Author Response

Please see uploaded file

Author Response File: Author Response.pdf