Development and validation of a self-efficacy of childcare scale for older primiparas in Taiwan

Development and validation of a self-efficacy of childcare scale for older primiparas in Taiwan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development and validation of a self-efficacy of childcare scale for older primiparas in Taiwan Yu Ming Lai, Yumi Suzuki This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8463765/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 17 You are reading this latest preprint version Abstract Background The average age of women giving birth to their first child has increased. However, no childcare self-efficacy scale specifically designed for older primiparas has been developed. Aims To develop the Self-Efficacy of Childcare Scale for older primiparas in Taiwan and to examine its reliability and validity. Methods This study conducted a literature review and extracted content from qualitative longitudinal surveys to clarify the conceptual structure of childcare self-efficacy among older primiparas in Taiwan. An initial item pool was developed and refined through expert review to ensure content validity. A preliminary survey of 140 older primiparas (aged ≥ 34 years) was conducted to perform exploratory factor analysis for item reduction and factor identification. A subsequent main survey involving 195 participants was used to confirm the scale structure through confirmatory factor analysis (CFA). Results Factor analysis resulted in a final scale comprising 10 items grouped into five factors: responsiveness in parenting, sense of mission related to parenting, parenting support, parenting evaluation, and parenting construction. The Cronbach’s α coefficient for the overall scale was 0.855. CFA revealed good model fit, with a goodness of fit index of 0.947, an adjusted goodness of fit index of 0.884, a comparative fit index of 0.955, and a root mean square error of approximation of 0.080. Significant correlations were observed with related constructs, including mothers’ feelings, support networks, and self-rated health status. Conclusion The Self-Efficacy of Childcare Scale demonstrated acceptable reliability and validity. This scale may serve as a useful assessment and screening tool in obstetric care settings in Taiwan. Older primipara Self-efficacy of childcare scale Scale development Parenting support Figures Figure 1 1. Introduction According to statistics from the Ministry of the Interior, Republic of China (Taiwan), the average age of women giving birth to their first child increased from 27.15 years in 2003 to 31.65 years in 2024, an increase of 4.5 years [ 1 ]. This trend is attributable to changes in personal career planning, including higher levels of educational attainment and increased employment among women, both of which lead to delayed marriage and parenthood. In response to the rising age of primiparas, the Taiwanese government has enhanced maternity protection policies and introduced support measures for working mothers. Notably, 64.51% of childbearing women in Taiwan remain employed, although the specific factors responsible for this retention remain unclear [ 2 ]. Nevertheless, research indicates that 86.41% of Taiwanese women who resign after childbirth cite difficulty in balancing work and child care as their primary reasons for doing so [ 2 ]. Moreover, 83.34% of parental leave applicants in Taiwan are women, indicating a disproportionate burden of caregiving responsibilities [ 3 ]. This gender disparity in parental leave further complicates women’s efforts toward managing both their professional and their domestic responsibilities, potentially resulting in delayed childbearing. Approximately 31.98% of primiparas in Taiwan are now aged 35 years or older [ 4 ]. However, the Ministry of Health and Welfare (Taiwan) [ 5 ] defines advanced maternal age as 34 years or older. In consideration of this, the present study defined “older first-time mothers” as those aged 34 years and older. Notably, the proportion of older first-time mothers is increasing worldwide. According to the Organization for Economic Cooperation and Development (OECD), the average age of first-time mothers in OECD countries exceeded 30 years in 2020, which indicates that delayed childbearing is a worldwide trend [ 6 ]. This global context demonstrates the broader relevance of the present study. The literature indicates that even women who have established careers and have delayed motherhood experience difficulty in balancing work, household responsibilities, and child care [ 7 ]. The aforementioned demographic shift toward older first-time motherhood not only reflects an increasing prevalence of this population of mothers but also indicates increased complexity in such women’s dual roles as professionals and new mothers, with this complexity intensifying the psychological demands of each role. Given these dual role pressures, it is crucial to consider psychological resources that may support effective parenting. In this context, childcare self-efficacy—defined as mothers’ confidence in their ability to care for and nurture their children—is a critical factor influencing successful parenting. According to Bandura’s social cognitive theory, self-efficacy is an individual’s belief in their capacity to perform the behaviors necessary to achieve specific goals [ 8 ]. When this theory is applied to parenting, it reflects mothers’ confidence in effectively raising and caring for their children [ 9 ]. Studies have demonstrated that various factors affect childcare self-efficacy, including child temperament [ 10 ], the quality of parent–child interactions [ 11 ], and mothers’ perceptions of their breastfeeding adequacy and coping ability [ 12 ]. For older first-time mothers who remain in the workforce, strengthening childcare self-efficacy is crucial to reducing parenting-related anxiety and supporting positive outcomes. Research identified emotional states associated with child-rearing as key determinants of self-efficacy [ 13 ]. For example, Aramaki and Muto [ 14 ] indicated that parenting anxiety can undermine maternal confidence. A study reported that older primiparas in Taiwan often encounter societal pressure [ 15 ]. Such women experience discrimination and prejudice that may cause them to feel uncomfortable or pressured about having children later in life [ 15 ]. Such discrimination can be observed in medical debates, media representations, and everyday conversations. For example, during a Valentine’s Day press conference, the Deputy Director-General of the National Health Bureau in Taiwan advised the younger generation to have their first child before the age of 30 years to reduce the risk of chromosomal abnormalities in offspring [ 16 ]. These demographic and sociocultural dynamics indicate the importance of understanding and supporting the psychological adjustment of older first-time mothers, including the importance of fostering their confidence in managing childcare. Given the aforementioned societal factors and official recommendations, ensuring older first-time mothers develop positive emotions toward parenting is crucial. Maintaining a positive outlook when navigating the complexities of childcare may enhance their self-efficacy. This indicates that self-confidence is essential in managing challenges associated with parenting. The concept of childcare self-efficacy, particularly that among older first-time mothers, warrants further academic investigation. Current instruments for measuring such self-efficacy, such as the widely used Breastfeeding Self-Efficacy Scale–Short Form [ 17 , 18 ], primarily focus on breastfeeding confidence and do not address the broader dimensions of childcare or the unique challenges encountered by older first-time mothers, including concerns related to their advanced maternal age and societal expectations. Thus, a tailored instrument that can comprehensively determine childcare self-efficacy in older primiparas must be developed. Accordingly, the present study developed and validated the Self-Efficacy of Childcare Scale for this population in Taiwan and examined its reliability and validity. 2. Research methodology 2.1. Item generation procedure The initial conceptual framework of this scale was informed by a qualitative study conducted by the author in 2003, in which semi-structured interviews were performed with first-time mothers aged 40 years and above. Based on previous study, Lai [ 19 ] conducted semistructured interviews with first-time mothers aged 40 years and older at three postpartum intervals: during hospitalization, 1 week after discharge, and 2 weeks after discharge. The interviews explored the mothers’ initial emotional responses upon meeting their child, their early experiences with childcare 1 to 2 weeks after discharge, and their current feelings about childcare. Although these qualitative data were collected in 2003 and the longitudinal survey period was limited to 2 weeks postpartum, which may limit the data’s relevance to the evolving challenges encountered by older primiparas in 2024 (when the average age of first-time mothers in Taiwan reached 31.65 years), they served as a critical foundation for the initial conceptualization of the current study’s scale. The narrative data were analyzed using qualitative and inductive methods. Statements related to childcare self-efficacy were extracted, categorized, and coded, and their original meaning was preserved. Frequently recurring codes in the context of childcare self-efficacy were prioritized and categorized on the basis of their semantic similarity, with this resulting in three thematic categories of postpartum parenting behaviors: constructing behaviors, evaluating behaviors, and adjusting behaviors. These themes were used as the foundational framework for the development of questionnaire items. Additional content was derived from a literature review that focused on empirical studies involving first-time mothers aged 34 years and older [ 20 , 21 ]. To ensure content validity, the research team engaged in multiple discussions with two midwifery experts from Taiwan until a consensus was reached. The research process was supervised by experts in qualitative analysis methodology. To determine face validity, 34 mothers (age unspecified) who were 1 month postpartum reviewed the items for clarity and other related factors. Responses were rated on a 4-point Likert scale with endpoints ranging from 1 ( strongly disagree ) to 4 ( strongly agree ). Higher scores indicated higher levels of parenting self-efficacy. An inverse scoring method was used for reverse-scored items (Items 14, 15, and 19): a score of 4 was converted to 1, and a score of 3 was converted to 2. The original draft of the questionnaire comprised 20 items grouped under 3 factors. On the basis of Bandura’s self-efficacy theory [ 8 ], the present study established a conceptual framework in which childcare self-efficacy was defined as “the level of confidence one has in their ability to handle experiences or new situations encountered in childcare.” According to Bandura, four factors affect self-efficacy: mastery experiences, verbal persuasion, emotional and physiological states, and vicarious experiences. Emoto [ 22 ] later expanded this model by introducing six additional elements: meaning-making for behavior, behavioral strategies, attribution of causes, social support, cognitive abilities, and health status. In the present study, seven conceptual factors were considered: Bandura’s original four factors and three additional factors, namely, mothers’ feelings, support networks, and self-rated health status. The inclusion of these additional factors was based on the observation that health status and social support, as indicated in Emoto’s conceptual framework, are closely aligned with the factors identified in the current study. 2.2. Development of a prototype and assessment of reliability and validity On the basis of the item pool and initial factor structure derived from three master’s theses [ 19 – 21 ], a literature review, and expert evaluations, a preliminary survey was conducted using the initial version of the Self-Efficacy of Childcare Scale, which comprised 20 items grouped into 3 factors. The survey was administered between November 2018 and September 2019 and included 140 first-time mothers aged 34 years or older who were literate in Chinese, had no major perinatal complications (e.g., preeclampsia or gestational diabetes requiring intensive management), and had delivered singleton, low-risk infants. This sample size was considered appropriate for preliminary item and exploratory factor analyses because it is in line with standard practices for initial scale validation. Participants were recruited during 1 to 2 month postpartum checkups at both an urban tertiary hospital and a regional community hospital in Taiwan to ensure representation across diverse socioeconomic backgrounds. Mothers of infants with extremely low birth weights (less than 1500 g) were excluded. After item analysis, one item (Item 3; p > 0.05) was excluded. Exploratory factor analysis was conducted on the remaining 19 items. The Kaiser–Meyer–Olkin measure of sampling adequacy was 0.793, and Bartlett’s test of sphericity was significant ( p < 0.001), confirming the suitability of the data for factor analysis. Given the assumed independence of the subscales, factor extraction was performed using exploratory factor analysis with orthogonal (Varimax) rotation. Exploratory factor analysis was conducted by examining eigenvalues and scree plots to identify the underlying factor structure. Factors were retained until a noticeable decrease in eigenvalues was observed. This study adhered to the criterion that retained factors must have eigenvalues greater than 1.0. The analysis yielded five factors, which collectively accounted for 67.548% of the total variance. Items 16 and 20 were excluded because of their low factor loadings (< 0.40), which brought the total number of excluded items to three. The resulting prototype version of the Self-Efficacy of Childcare Scale comprised 17 items grouped into 5 factors: responsiveness in parenting, sense of mission related to parenting, parenting support, parenting evaluation, and parenting construction. Item–total correlation analysis revealed positive correlations between the subscales, with correlation coefficients ranging from r = 0.256 to r = 0.450, with all significant at the 1% level (two-tailed; Table 1 ). Table 1 Exploratory factor analysis results. Item First factor Second factor Third factor Fourth factor Fifth factor Communality Factor 1: Responsiveness in parenting 9 I plan to continue breastfeeding. 0.832 0.129 0.153 −0.53 −0.93 0.744 10 To increase breast milk production, I will consume more soup. 0.778 0.176 0.301 0.53 0.42 0.732 13 I feel confident in handling any situation. 0.712 0.209 −0.19 −0.02 0.116 0.602 11 I can manage my children in an orderly manner, even when multitasking, without feeling rushed. 0.637 0.56 0.01 0.18 0.410 0.61 12 I envision my child’s future growth and plan for it diligently. 0.444 0.333 0.364 0.093 0.065 0.453 Factor 2: Sense of mission related to parenting 4 As a mother, my responsibility is to care for my child. 0.001 0.827 0.095 0.095 0.109 0.715 6 Regardless of my fatigue, I can fulfill my role as a mother. 0.379 0.695 0.018 −0.133 0.202 0.686 2 I am committed to caring for my children wholeheartedly and ensuring they are in the best possible condition. 0.169 0.686 0.216 0.048 0.007 0.548 5 I believe in my ability to provide excellent care for my children. 0.211 0.609 −0.05 0.066 0.473 0.647 1 I will always strive to provide the best possible care for my children. 0.293 0.597 0.472 0.221 0.027 0.715 Factor 3: Parenting support 17 If I encounter a challenge, I will seek guidance from knowledgeable individuals or professionals to ensure that the information I have on parenting is accurate. 0.185 0.173 0.777 0.142 0.187 0.723 18 When feeling overwhelmed or physically exhausted, I turn to my husband’s family and friends for support. −0.009 0.118 0.768 0,018 0.229 0.657 Factor 4: Parenting evaluation 15 I am aware of certain child-rearing methods, but I have found them impractical and unfeasible. −0.016 0.076 0.147 0.874 −0.03 0.793 14 I feel I am still not adept at caring for my children independently and am uncertain about the next steps. 0.074 0.049 −0.04 0.829 0.22 0.746 19 When dissatisfied with my current childcare approach, I feel powerless and reluctant to seek a means of improving it. 0.044 0.027 0.552 0.627 0.087 0.708 Factor 5: Parenting construction 7 I learn about how to raise children by observing how my family and friends raise their children. 0.169 0.298 0.253 0.007 0.749 0.742 8 I gather knowledge on child care from newspapers, magazines, and online sources. −0.018 0.05 0.35 0.224 0.698 0.662 Correlation between item and factors ー 0.256 ** 0.301 ** 0.345 ** 0.408 ** ー 0.289 ** 0.450 ** 0.272 ** ー 0.403 ** 0.380 ** ー 0.350 ** ー Factor extraction method: Principal component analysis. Rotation method: Varimax method with Kaiser regularisation. ** Correlation coefficients with a significance level of 1%. 2.3. Creation of self-efficacy of childcare scale and analysis of reliability and validity For the main survey, participants completed a comprehensive questionnaire comprising 79 items. These included 10 demographic questions, 17 items from the prototype version of the Self-Efficacy of Childcare Scale, 17 items from Aramaki and Muto’s [ 14 ] Mother’s Feeling Scale, 10 items from the Support Network Scale developed by Hung et al. [ 23 ], 11 items from Chang’s [ 24 ] Self-Perceived Health Status Scale, and 14 items from Hu’s [ 25 ] Breastfeeding Self-Efficacy Scale. Data were collected using a Likert scale between September 2019 and June 2020. The study sample comprised 195 first-time mothers; the inclusion criteria for these mothers matched those used in the preliminary survey. This sample size was considered adequate for conducting robust psychometric analyses, including confirmatory factor analysis (CFA), and is consistent with established recommendations for scale validation studies. 2.4. Analysis The psychometric properties of the scale were examined using multiple statistical analyses. Internal consistency was measured using Cronbach’s alpha (α). Construct validity was examined through CFA conducted in SPSS Amos (Version 24), and model fit was determined using the chi-square statistic (χ²), comparative fit index (CFI), goodness of fit index (GFI), and root mean square error of approximation (RMSEA). Convergent and discriminant validity were evaluated by examining factor loadings, composite reliability (CR), and average variance extracted (AVE) and by comparing the square roots of the AVE with the correlations between factors. To identify constructs related to childcare self-efficacy among older primiparas, Pearson’s correlation coefficients were calculated between the total childcare self-efficacy score and related constructs, including mother’s feelings, support networks, self-rated health status, and breastfeeding self-efficacy. Criterion validity was evaluated using the Pearson’s correlation coefficients between the scale and related constructs. 2.5. Ethical considerations Ethical approval for the preliminary survey was obtained from the Ethics Committee of the International University of Health and Welfare (Approval No. 18-Io-127) on November 29, 2018. Approval for the main survey was obtained from the Ethics Review Committee of Taoyuan General Hospital, Ministry of Health and Welfare, Taiwan (Approval No. TYGH108016), on September 19, 2019. Written informed consent was obtained from all participants prior to their participation in both the preliminary and the main questionnaire surveys. The consent form provided a clear explanation of the study objectives, confidentiality measures, data security protocols, and the participants’ right to withdraw at any time without consequence. Participants were assured that their decision to participate would not affect them adversely and that all collected data would be used exclusively for research purposes. This study represents a modified section of a doctoral dissertation submitted to the Graduate School of Health and Welfare Sciences at the International University of Health and Welfare. 3. Results 3.1. Demographic characteristics of the study population The demographic characteristics of the 195 first-time mothers aged 34 years or older who participated in the main survey are summarized in the following. The participants had an average age of 37.03 ± 2.35 years. Among them, 109 (55.9%) were employed, and 154 (79.0%) had attained at least a college-level education. Most of their spouses were employed, with 117 (60.0%) working in a company. Regarding family structure, 117 (60.0%) participants lived in nuclear families. A total of 130 (66.7%) mothers reported that their pregnancy was planned. With respect to the mode of delivery, 80 (41.0%) had a vaginal birth, whereas 115 (59.0%) underwent a cesarean section. In terms of sex preference, 99 (50.8%) participants indicated no preference. In addition, 176 (90.2%) participants reported no abnormalities in their newborns at birth. Regarding infant feeding practices, 116 (59.5%) used mixed feeding, and 67 (34.4%) combined direct breastfeeding with bottle feeding. Finally, 141 (72.3%) participants rated their economic status as “satisfactory” (Table 2 ). Table 2 Demographic characteristics of first-time mothers aged ≥ 34 years (n = 195). Characteristics n (%) Employment status Employed 109 (55.9) Unemployed 86 (44.1) Education level College degree or above 154 (79.0) Below college degree 41 (21.0) Spouse employment status Employed (company employee) 117 (60.0) Other 78 (40.0) Family structure Nuclear family 117 (60.0) Nonnuclear family 78 (40.0) Pregnancy planning Planned 130 (66.7) Unplanned 65 (33.3) Mode of delivery Vaginal childbirth 80 (41.0) Cesarean section 115 (59.0) Sex preference for child No preference 99 (50.8) With preference 96 (49.2) Newborn health status No abnormalities 176 (90.2) With abnormalities 19 (9.8) Infant feeding practices Mixed feeding 116 (59.5) Direct breastfeeding and bottle feeding 67 (34.4) Other 12 (6.1) Self-assessed economic status Satisfactory 141 (72.3) Unsatisfactory 54 (27.7) 3.2. CFA CFA was conducted on the 17-item prototype version of the Self-Efficacy of Childcare Scale developed in the preliminary survey. These 17 items were treated as observed variables in the structural equation model, whereas the 5 identified factors were used as latent variables. The initial CFA was used to evaluate model fit through several indices. The results were as follows: GFI = 0.752, adjusted GFI (AGFI) = 0.652, CFI = 0.737, and RMSEA = 0.134. Because the RMSEA was greater than the recommended threshold of 0.08, the model was modified on the basis of modification indices to improve fit. The revisions included the removal of items that significantly reduced the chi-square value and the addition of covariance paths. After modification, the fit indices improved substantially: GFI = 0.947, AGFI = 0.884, CFI = 0.955, and RMSEA = 0.080. These revised metrics met or exceeded commonly accepted criteria, supporting the model’s overall fit. Although the initial indices fell below standard thresholds, this iterative refinement process indicates the scale’s sensitivity to item structure and the importance of careful scale optimization in future similar studies. All estimated values and interfactor correlation coefficients, ranging from r = 0.37 to r = 0.53, were significant ( p < 0.001), indicating meaningful covariance among the five factors. Additionally, the standardized path coefficients between the latent variables and their corresponding observed variables ranged from 0.60 to 0.96 (Fig. 1 ). 3.3. Analysis of construct concept validity Significant correlations were observed between the Self-Efficacy of Childcare Scale, its subscales, and the overall scale. As illustrated in Fig. 1 , all items met the established criterion, with correlation coefficients equal to or greater than 0.2. Although all correlations exceeded the minimum acceptable threshold, values near the lower end suggest that certain item responses are affected by cultural or contextual factors. This finding warrants further exploration through additional qualitative investigations. Convergent validity was evaluated using two indicators: CR and AVE. All five factors met the recommended thresholds (CR ≥ 0.6, AVE ≥ 0.5) [ 26 ], with CR values ranging from 0.768 to 0.805 and AVE values ranging from 0.622 to 0.674 (Table 3 ). Table 3 Confirmatory factor analysis results. Subscale Item No. Item Loading α CR AVE F1: 9 I plan to continue breastfeeding. 0.73 0.786 0.782 0.644 10 To increase breast milk production, I will consume more soup. 0.87 F2: 4 As a mother, my responsibility is to care for my child. 0.82 0.811 0.768 0.622 5 I believe in my ability to provide excellent care for my children. 0.76 F3: 17 If I encounter a challenge, I will seek guidance from knowledgeable individuals or professionals to ensure that the information I have on parenting is accurate. 0.85 0.769 0.805 0.674 18 When feeling overwhelmed or physically exhausted, I turn to my husband’s family and friends for support. 0.0.79 F4: 14 I feel I am still not adept at caring for my children independently and am uncertain about the next steps. 0.87 0.761 0.787 0.65 15 I am aware of certain child-rearing methods, but I have found them impractical and unfeasible. 0.74 F5: 7 I learn about how to raise children by observing how my family and friends raise their children. 0.96 0.695 0.772 0.64 8 I gather knowledge on childcare from newspapers, magazines, and online sources. 0.60 χ 2 = 56.128 (df = 25, p < 0.001), GFI = 0.947, AGFI = 0.884, CFI = 0.955, and RMSEA = 0.080. α = Cronbach’s alpha; CR = Composite Reliability; AVE = Average Variance Extracted. Discriminant validity was established by confirming that the square root of the AVE for each factor was greater than the corresponding interfactor correlations. In addition, all correlation coefficients among the five latent variables satisfied the 95% confidence interval criterion of ≠ 1. The square roots of the AVE for each factor ranged from 0.789 to 0.821, supporting the presence of discriminant validity (Table 4 ). Table 4 Results of confirmatory factor analysis: correlation coefficient between factors. Criterion F1 F2 F3 F4 F5 F1 0.803 F2 0.368*** 0.789 F3 0.424*** 0.367*** 0.821 F4 0.444*** 0.553*** 0.527*** 0.806 F5 0.450*** 0.443*** 0.413*** 0.486*** 0.8 *** p < 0.001. Criterion validity was assessed by examining the correlations between the total score of the Self-Efficacy of Childcare Scale and theoretically related constructs, including support networks, and self-rated health status subscales (r = − 0.251 to 0.349, p < 0.01; Table 5 ). The total score of the Self-Efficacy of Childcare Scale was also significantly correlated with the scores of the five identified factors (r = 0.654 to 0.725, p < 0.01). Furthermore, a significant but weak positive correlation was found between the total score of the Breastfeeding Self-Efficacy Scale and Factor 1 (responsiveness in parenting) of the Self-Efficacy of Childcare Scale (r = 0.238, p < 0.01). These findings collectively provide evidence supporting the criterion validity of the scale. Collectively, these findings support the construct validity of the Self-Efficacy of Childcare Scale. From a practical perspective, these correlations suggest that the scale may serve as an effective screening tool in postpartum care for identifying older first-time mothers who could benefit from targeted psychosocial support and highlighting areas for future tailored interventions. Table 5 Criterion validity of the self-efficacy of childcare scale. Related constructs Correlation coefficient (r) p value Mothers’ feelings 0.349 < 0.01 Support networks 0.275 < 0.01 Self-rated health status −0.251 < 0.01 Breastfeeding self-efficacy scale vs. factor 1 0.238 < 0.01 3.4. Analysis of reliability Internal consistency was calculated using Cronbach’s α for each of the five factors. The α values were 0.786 for Factor 1, 0.811 for Factor 2, 0.769 for Factor 3, 0.761 for Factor 4, and 0.695 for Factor 5. The overall α coefficient for the scale was 0.855. Factor 5 exhibited a slightly lower α value, which indicates the potential for future refinement of its items. The overall internal consistency was robust, supporting the reliability of the scale. 4. Discussion CFA indicated that the model demonstrated a robust fit, which supports the construct validity of the scale. However, the number of items for each factor can affect reliability coefficients. Each factor should ideally contain at least three items to ensure robustness [ 27 ]. In the present scale, each factor included only two items, which may have affected the reliability estimates. However, the scale’s validity is supported by its high α coefficients and strong factor loadings. Factor loadings of 0.50 or higher are considered acceptable indicators of scale validity [ 28 ], and in this study, the α coefficients ranged from 0.695 to 0.811, with factor loadings ranging from 0.60 to 0.96. These results suggest that the scale not only captures breastfeeding-related dimensions but also reflects broader constructs of childcare self-efficacy, supporting its potential application in comprehensive postpartum assessments. Nonetheless, the reliance on self-reported data and the absence of longitudinal follow-up beyond the early postpartum period may have introduced recall or social desirability biases, potentially inflating the observed psychometric strengths. Future studies incorporating objective measures and longer follow-up periods may help clarify these limitations. The present study identified several factors associated with maternal self-efficacy in childcare, as measured using the Self-Efficacy of Childcare Scale. Among them, mothers’ feelings demonstrated a significant but weak positive correlation with the overall self-efficacy score. This finding is consistent those of previous studies conducted by Murai and Ryugo [ 13 ] and Aramaki and Muto [ 14 ] who reported that emotional factors, particularly parenting anxiety, which is a common negative emotional state in the early postpartum period, can affect maternal self-efficacy. Because it can identify mothers experiencing a high level of parenting anxiety, including those in the puerperal period, the current scale can guide the development of targeted support interventions to enhance maternal confidence in childcare. Further supporting its utility, Miyanoki et al. [ 29 ] noted an increase in the prevalence of nuclear families in Asia, with an absence of extended family members within a household limiting available support. This shift has led to an increased parenting burden and a high level of parenting anxiety, indicating the current scale’s relevance for assessing anxiety in older primiparous women living in nuclear family settings prior to hospital discharge. These findings highlight the importance of early interventions, such as postpartum counseling or emotional regulation programs, to enhance maternal self-efficacy in high-risk groups. In addition to emotional factors, the present study identified a significant but weak positive correlation between mothers’ support networks and their self-efficacy scores. Higher maternal confidence and satisfaction in the first postpartum month are associated with the quality of spousal relationships and the perceived adequacy of social support, particularly with respect to mothers feeling heard and understood when expressing concerns [ 30 , 31 ]. Assessing the breadth and quality of mothers’ support networks, including their familial and broader social relationships, is therefore critical. Because such assessments can be conducted during pregnancy, they can be used to ensure early, tailored interventions are implemented following childbirth. Incorporating such evaluations into routine prenatal care can enable timely implementation of supportive measures designed to enhance perceived social support, thereby improving maternal self-efficacy. In the current study, self-rated health status exhibited a significant but weak negative correlation with overall childcare self-efficacy, indicating that better perceived health is associated with lower parenting-related stress and higher self-efficacy. This finding is consistent with that of Chang [ 24 ] who identified self-rated health as a crucial factor affecting maternal self-efficacy. Older primiparous women are particularly aware of postpartum health challenges, including fatigue and physical limitations [ 32 ]. In Taiwan, where women undertake substantially more household chores than men do [ 2 ], the combined burden of housework and parenting can adversely affect physical and mental well-being. Supporting physical and mental health is thus critical to maintaining favorable self-rated health and enhancing parenting self-efficacy, particularly in older first-time mothers. In clinical settings, midwives may use the scale developed in the present study to evaluate mothers’ self-rated health status and raise awareness of its role in parenting confidence. More broadly, the findings of the present study support incorporating the scale into structured postpartum intervention programs that address physical health, emotional well-being, and the development of childcare self-efficacy in a coordinated manner. Although correlation analyses were performed, these were conducted solely to evaluate the criterion validity of the scale rather than to explore causal relationships or predictive factors. Future studies using longitudinal designs or multivariate analyses are recommended to further clarify factors associated with childcare self-efficacy. 5. Conclusion This study validated the Self-Efficacy of Childcare Scale for older primiparous women in Taiwan. The final scale comprises 10 items across 5 subscales: responsiveness in parenting, sense of mission related to parenting, parenting support, parenting evaluation, and parenting construction. Psychometric analysis revealed the scale to have acceptable reliability and construct validity, supporting the use of this instrument to assess childcare self-efficacy in the target population. A limitation of this study is its use of convenience sampling, which may introduce selection bias and limit the generalizability of the findings. Participants were recruited from a small number of health-care facilities, which may not fully reflect the diverse experiences among older primiparous women across different regions or health-care settings in Taiwan. Future research employing randomized or stratified sampling approaches could improve external validity and broaden the applicability of the scale. Beyond research applications, this scale could also inform public health policies by serving as a screening and evaluation tool in maternal and child health programs. It could facilitate the early identification of mothers with low childcare self-efficacy, enabling policymakers to design targeted interventions, allocate resources effectively, and support maternal mental health and positive parenting outcomes. Declarations Ethics approval and consent to participate This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the following committees : Ethics Committee of the International University of Health and Welfare, Japan (Approval No. 18-Io-127; Date: November 29, 2018). Ethics Review Committee of Taoyuan General Hospital, Ministry of Health and Welfare, Taiwan (Approval No. TYGH108016; Date: September 19, 2019) Written informed consent was obtained from all participants prior to participation. The consent form explained the study objectives, confidentiality measures, data security protocols, and participants’ right to withdraw at any time without consequence. Consent for publication Not applicable. Availability of data and materials The datasets analyzed during the current study are not publicly available due data protection measures but are available from the corresponding author on reasonable request. Competing interest The authors declare that they have no competing interests. Funding This research was part of a PhD thesis at the International University of Health and Welfare, Japan , and received no external funding. Authors' contributions Yu Ming Lai: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Resources; Software; Validation; Visualization; Roles/Writing - original draft; and Writing - review & editing. Yumi Suzuki: Conceptualization; Formal analysis; Methodology; Project administration; Supervision; and Writing - review & editing. All authors read and approved the final manuscript. Acknowledgements The author would like to thank the Taiwan older mothers who participated in the study. It is also very grateful for the guidance provided by Professor Keiiti Saito and Professor Midori Kuroda at the Japan International University of Health and Welfare about statistical analysis and questionnaire design. References Gender Equality Committee of the Executive Yuan. Republic of China (Taiwan), Gender equality committee. Important gender statistics database. https://www.gender.ey.gov.tw/gecdb/Stat_Statistics_DetailData.aspx?sn=lT4902z3YmLGBZadLKLSzQ%40%40&d , 2024. Directorate-General of Budget, Accounting, and, Statistics E, Yuan. Republic of China (Taiwan), Survey on women's marriage, childbirth, and employment. asp?xItem=41524&ctNode=6426∓=4; 2016. https://www.stat.gov.tw/ct. . Ministry of Labor. Republic of China (Taiwan), Survey on support and care for the completion of maternity leave. https://statdb.mol.gov.tw/html/svy08/0822summary.pdf , 2019. Ministry of Health and Welfare. Republic of China (Taiwan), National health agency annual report. https://www.hpa.gov.tw/Pages/List.aspx?nodeid=4870 , December 2024. Ministry of Health and Welfare. Republic of China (Taiwan), Advanced maternal age is associated with increased risks. https://www.mohw.gov.tw/cp-4260-46493-1.html , February 2019. OECD. Health at a Glance 2021: OECD Indicators. Paris: OECD Publishing; 2021. Watanabe H. Effects of career self-efficacy on the reemployment status of married women. J Health Psychol Res. 2018;30:153–9. https://doi.org/10.11560/jhpr.160905052 . Bandura A. Self-Efficacy: The Exercise of Control. New York: Worth; 1997. Jones TL, Prinz RJ. Potential roles of parental self-efficacy in parent and child adjustment: a review. Clin Psychol Rev. 2005;25:341–63. https://doi.org/10.1016/j.cpr.2004.12.004 . Takei Y, Kadota M, Okutomi Y, Takeuchi I, Okano I, Iwado M, Terasaki M. Effects of a baby massage based on children’s temperament on childcare anxiety and parenting self-efficacy. J Child Health. 2021;80:38–45. Kanzaki M, Fujiwara C. Effects of family function on antenatal depression and parenting self-efficacy of Japanese primiparas in the second and third trimesters of pregnancy. Jpn Soc Psychosom Obstetr Gynecol. 2015;20:193–206. https://doi.org/10.18977/jspog.20.2_193 . Nakatani M, Obayashi Y, Tanimura S, Shinkoda H. Breastfeeding self-efficacy of mothers with infants in the neonatal intensive care unit beyond one month from starting breastfeeding and the related factors. J Jpn Acad Nurs Sci. 2020;40:168–76. https://doi.org/10.5630/jans.40.168 . Murai H, Ryugo C. Relationships among difficulties of child rearing by mothers with childhood later stage children, their self-efficacy and social support. Seisen J Nurs Stud. 2020;9:27–34. https://doi.org/10.34359/00001276 . Aramaki M, Muto T. Factors related to negative and positive feelings about child-rearing: a survey of mothers of young children. Jpn J Dev Psychol. 2008;19:87–97. https://doi.org/10.11201/jjdp.19.87 . Chen ML. Medical treatments and social prejudice of women giving birth after thirty-five: a reflection. Appl Psychol Res. 2018;69:207–51. https://doi.org/10.3966/156092512018120069007 . National Health Agency. Ministry of Health and Welfare, Republic of China (Taiwan), Let love continue to blossom. Detail.aspx?nodeid=1126&pid=1731; 2015. https://www.hpa.gov.tw/Pages/ . Li FH, Wang KM, Kao YH. The influence of background factors in breastfeeding experience and breastfeeding self-efficacy among primiparous. J Nurs. 2012;54:56–67. https://doi.org/10.6518/TJOM.2012.54.7 . Wu YH, Ho YJ, Han JP. The influence of breastfeeding self-efficacy and breastfeeding intention on breastfeeding behavior in postpartum women. J Nurs. 2018;65:42–50. https://doi.org/10.6224/JN.201802_65(1).07 . Lai YM. A study of the course of motherhood and the social support for elderly primiparas, National Yang-Ming University, Graduate Institute of Clinical Nursing Master's Thesis, 2003. Hsiung YL. The maternal career process and social support of older primiparas, Yuan-Ze University, Graduate Institute of Information and Social Work Master's Thesis, 2009. Chen CJ. Comparing maternal confidence and social support between younger and elder primiparas in the early postpartum period. National Taiwan University, Graduate Institute of Nursing Science Master's Thesis, 2010. Emoto R. Concept analysis of self-efficacy. J Jpn Acad Nurs Sci. 2000;20:39–45. https://doi.org/10.5630/Jans1981.20.2_39 . Hung CH, Chung HH, Liu YH. Correlates of couples’ attitudes toward husband’s childbirth participation, Kaohsiung Med. Univ J Hum Soc Sci. 1997;13:360–9. https://doi.org/10.5452/KJMS.199706.0360 . Chang YF. A study among teacher stress, social support and health of the elementary teachers, National Chiayi University, Master's Thesis, 2001. Hu LJ. A Study on Self-efficacy and Satisfaction of Breastfeeding Mothers in Baby-friendly Hospitals, Zhongshan Medical University Teachers Special Research Program No. CSMU 92-OM-019. Taichung City: Chung Shan Medical University; 2003. Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Market Res. 1981;18:39–50. https://doi.org/10.1177/002224378101800104 . Fayer PM, Machin D. Quality of Life: The Assessment, Analysis and Interpretation of Patient-reported Outcomes. Chichester: Wiley; 2007. Costello AB, Osborne JW. Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. Pract Assess Res Eval. 2005;10:7. https://doi.org/10.7275/jyj1-4868 . Miyanoki H, Kizaki T, Nakajima R, Muramatu S, Kakiuti H, Shibata M, Nakano H. Mothers’ child-care problems on infant: relationship between development of infants and mothers’ child-care problems. Aino J. 2004;17:124–8. https://cir.nii.ac.jp/crid/1050282676666306304 . Hoshina C. Factors affecting the self-efficacy of elderly primiparas for childcare, International University of Health and Welfare, Master's Thesis, 2017. Mori E. Developing nursing guidelines for childrearing support in Japanese older primiparas, Advanced Research Grant (Cutting-Edge, Next-Generation Research and Development Support Program). Project Number. 2015;LS022:111–9. Mori E, Maehara K, Iwata H. Childrearing experiences of older primiparas at 4 months postpartum. J Jpn Matern Nurs. 2019;19:23–30. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 13 Apr, 2026 Reviews received at journal 15 Feb, 2026 Reviews received at journal 13 Feb, 2026 Reviewers agreed at journal 11 Feb, 2026 Reviews received at journal 11 Feb, 2026 Reviews received at journal 07 Feb, 2026 Reviews received at journal 07 Feb, 2026 Reviewers agreed at journal 07 Feb, 2026 Reviewers agreed at journal 06 Feb, 2026 Reviewers agreed at journal 06 Feb, 2026 Reviewers agreed at journal 31 Jan, 2026 Reviewers agreed at journal 30 Jan, 2026 Reviewers invited by journal 30 Jan, 2026 Editor assigned by journal 27 Jan, 2026 Editor invited by journal 09 Jan, 2026 Submission checks completed at journal 08 Jan, 2026 First submitted to journal 08 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8463765","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":583717105,"identity":"a9ccc06a-0f0f-4123-bd5b-96f71e445f98","order_by":0,"name":"Yu Ming Lai","email":"","orcid":"","institution":"Asia University","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"Ming","lastName":"Lai","suffix":""},{"id":583717106,"identity":"14552dad-7636-4429-b5b5-116a07119924","order_by":1,"name":"Yumi Suzuki","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYJACxgYDIMne2MAMFUggUgvPQZK0gEiJBAZmAgohQH5G+jPJGQUMiRtuPm6TLmxjkOdvYHj2AJ8WgxsJaZIbDIBabie2Sc9sYzCccYAh3QCvFomEY5IPDP5DtPBuY2DcwMCQJoHfYYltQC0ghx0Ea7EnqIXhRjIbxGE3GMFaEglqMTjzjNlyhgGD8cwzic3WvP8kkmccJuAX+fb0hzd7/jDI9h0//vA2zxkb2/72nrQHeB0GBY4NEBroJGaeNGJ0MNgjsdmPEaVlFIyCUTAKRgwAAH98SCgSfRRhAAAAAElFTkSuQmCC","orcid":"","institution":"International University of Health and Welfare","correspondingAuthor":true,"prefix":"","firstName":"Yumi","middleName":"","lastName":"Suzuki","suffix":""}],"badges":[],"createdAt":"2025-12-28 03:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8463765/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8463765/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101789271,"identity":"a0994bbb-b140-4fac-bd55-ea2fd98e9610","added_by":"auto","created_at":"2026-02-03 15:56:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":810056,"visible":true,"origin":"","legend":"\u003cp\u003eConfirmatory factor analysis result for self-efficacy in childcare.\u003c/p\u003e","description":"","filename":"Figure1formatted.png","url":"https://assets-eu.researchsquare.com/files/rs-8463765/v1/2b72db2d4559097566128bff.png"},{"id":101881527,"identity":"019addf3-d49a-42fe-b2ab-a25c0e82d508","added_by":"auto","created_at":"2026-02-04 15:12:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1703180,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8463765/v1/b1d43594-d5ad-41e4-a3dd-f7ce94ef8b78.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development and validation of a self-efficacy of childcare scale for older primiparas in Taiwan","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAccording to statistics from the Ministry of the Interior, Republic of China (Taiwan), the average age of women giving birth to their first child increased from 27.15 years in 2003 to 31.65 years in 2024, an increase of 4.5 years [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This trend is attributable to changes in personal career planning, including higher levels of educational attainment and increased employment among women, both of which lead to delayed marriage and parenthood. In response to the rising age of primiparas, the Taiwanese government has enhanced maternity protection policies and introduced support measures for working mothers. Notably, 64.51% of childbearing women in Taiwan remain employed, although the specific factors responsible for this retention remain unclear [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Nevertheless, research indicates that 86.41% of Taiwanese women who resign after childbirth cite difficulty in balancing work and child care as their primary reasons for doing so [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Moreover, 83.34% of parental leave applicants in Taiwan are women, indicating a disproportionate burden of caregiving responsibilities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This gender disparity in parental leave further complicates women\u0026rsquo;s efforts toward managing both their professional and their domestic responsibilities, potentially resulting in delayed childbearing. Approximately 31.98% of primiparas in Taiwan are now aged 35 years or older [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, the Ministry of Health and Welfare (Taiwan) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] defines advanced maternal age as 34 years or older. In consideration of this, the present study defined \u0026ldquo;older first-time mothers\u0026rdquo; as those aged 34 years and older. Notably, the proportion of older first-time mothers is increasing worldwide. According to the Organization for Economic Cooperation and Development (OECD), the average age of first-time mothers in OECD countries exceeded 30 years in 2020, which indicates that delayed childbearing is a worldwide trend [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This global context demonstrates the broader relevance of the present study.\u003c/p\u003e \u003cp\u003eThe literature indicates that even women who have established careers and have delayed motherhood experience difficulty in balancing work, household responsibilities, and child care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The aforementioned demographic shift toward older first-time motherhood not only reflects an increasing prevalence of this population of mothers but also indicates increased complexity in such women\u0026rsquo;s dual roles as professionals and new mothers, with this complexity intensifying the psychological demands of each role. Given these dual role pressures, it is crucial to consider psychological resources that may support effective parenting. In this context, childcare self-efficacy\u0026mdash;defined as mothers\u0026rsquo; confidence in their ability to care for and nurture their children\u0026mdash;is a critical factor influencing successful parenting. According to Bandura\u0026rsquo;s social cognitive theory, self-efficacy is an individual\u0026rsquo;s belief in their capacity to perform the behaviors necessary to achieve specific goals [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. When this theory is applied to parenting, it reflects mothers\u0026rsquo; confidence in effectively raising and caring for their children [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Studies have demonstrated that various factors affect childcare self-efficacy, including child temperament [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], the quality of parent\u0026ndash;child interactions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and mothers\u0026rsquo; perceptions of their breastfeeding adequacy and coping ability [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. For older first-time mothers who remain in the workforce, strengthening childcare self-efficacy is crucial to reducing parenting-related anxiety and supporting positive outcomes. Research identified emotional states associated with child-rearing as key determinants of self-efficacy [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. For example, Aramaki and Muto [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] indicated that parenting anxiety can undermine maternal confidence.\u003c/p\u003e \u003cp\u003eA study reported that older primiparas in Taiwan often encounter societal pressure [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Such women experience discrimination and prejudice that may cause them to feel uncomfortable or pressured about having children later in life [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Such discrimination can be observed in medical debates, media representations, and everyday conversations. For example, during a Valentine\u0026rsquo;s Day press conference, the Deputy Director-General of the National Health Bureau in Taiwan advised the younger generation to have their first child before the age of 30 years to reduce the risk of chromosomal abnormalities in offspring [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These demographic and sociocultural dynamics indicate the importance of understanding and supporting the psychological adjustment of older first-time mothers, including the importance of fostering their confidence in managing childcare.\u003c/p\u003e \u003cp\u003eGiven the aforementioned societal factors and official recommendations, ensuring older first-time mothers develop positive emotions toward parenting is crucial. Maintaining a positive outlook when navigating the complexities of childcare may enhance their self-efficacy. This indicates that self-confidence is essential in managing challenges associated with parenting.\u003c/p\u003e \u003cp\u003eThe concept of childcare self-efficacy, particularly that among older first-time mothers, warrants further academic investigation. Current instruments for measuring such self-efficacy, such as the widely used Breastfeeding Self-Efficacy Scale\u0026ndash;Short Form [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], primarily focus on breastfeeding confidence and do not address the broader dimensions of childcare or the unique challenges encountered by older first-time mothers, including concerns related to their advanced maternal age and societal expectations. Thus, a tailored instrument that can comprehensively determine childcare self-efficacy in older primiparas must be developed. Accordingly, the present study developed and validated the Self-Efficacy of Childcare Scale for this population in Taiwan and examined its reliability and validity.\u003c/p\u003e"},{"header":"2. Research methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Item generation procedure\u003c/h2\u003e \u003cp\u003eThe initial conceptual framework of this scale was informed by a qualitative study conducted by the author in 2003, in which semi-structured interviews were performed with first-time mothers aged 40 years and above. Based on previous study, Lai [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] conducted semistructured interviews with first-time mothers aged 40 years and older at three postpartum intervals: during hospitalization, 1 week after discharge, and 2 weeks after discharge. The interviews explored the mothers\u0026rsquo; initial emotional responses upon meeting their child, their early experiences with childcare 1 to 2 weeks after discharge, and their current feelings about childcare. Although these qualitative data were collected in 2003 and the longitudinal survey period was limited to 2 weeks postpartum, which may limit the data\u0026rsquo;s relevance to the evolving challenges encountered by older primiparas in 2024 (when the average age of first-time mothers in Taiwan reached 31.65 years), they served as a critical foundation for the initial conceptualization of the current study\u0026rsquo;s scale. The narrative data were analyzed using qualitative and inductive methods. Statements related to childcare self-efficacy were extracted, categorized, and coded, and their original meaning was preserved. Frequently recurring codes in the context of childcare self-efficacy were prioritized and categorized on the basis of their semantic similarity, with this resulting in three thematic categories of postpartum parenting behaviors: constructing behaviors, evaluating behaviors, and adjusting behaviors. These themes were used as the foundational framework for the development of questionnaire items. Additional content was derived from a literature review that focused on empirical studies involving first-time mothers aged 34 years and older [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. To ensure content validity, the research team engaged in multiple discussions with two midwifery experts from Taiwan until a consensus was reached. The research process was supervised by experts in qualitative analysis methodology. To determine face validity, 34 mothers (age unspecified) who were 1 month postpartum reviewed the items for clarity and other related factors. Responses were rated on a 4-point Likert scale with endpoints ranging from 1 (\u003cem\u003estrongly disagree\u003c/em\u003e) to 4 (\u003cem\u003estrongly agree\u003c/em\u003e). Higher scores indicated higher levels of parenting self-efficacy. An inverse scoring method was used for reverse-scored items (Items 14, 15, and 19): a score of 4 was converted to 1, and a score of 3 was converted to 2. The original draft of the questionnaire comprised 20 items grouped under 3 factors.\u003c/p\u003e \u003cp\u003eOn the basis of Bandura\u0026rsquo;s self-efficacy theory [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], the present study established a conceptual framework in which childcare self-efficacy was defined as \u0026ldquo;the level of confidence one has in their ability to handle experiences or new situations encountered in childcare.\u0026rdquo; According to Bandura, four factors affect self-efficacy: mastery experiences, verbal persuasion, emotional and physiological states, and vicarious experiences. Emoto [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] later expanded this model by introducing six additional elements: meaning-making for behavior, behavioral strategies, attribution of causes, social support, cognitive abilities, and health status.\u003c/p\u003e \u003cp\u003eIn the present study, seven conceptual factors were considered: Bandura\u0026rsquo;s original four factors and three additional factors, namely, mothers\u0026rsquo; feelings, support networks, and self-rated health status. The inclusion of these additional factors was based on the observation that health status and social support, as indicated in Emoto\u0026rsquo;s conceptual framework, are closely aligned with the factors identified in the current study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Development of a prototype and assessment of reliability and validity\u003c/h2\u003e \u003cp\u003eOn the basis of the item pool and initial factor structure derived from three master\u0026rsquo;s theses [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], a literature review, and expert evaluations, a preliminary survey was conducted using the initial version of the Self-Efficacy of Childcare Scale, which comprised 20 items grouped into 3 factors. The survey was administered between November 2018 and September 2019 and included 140 first-time mothers aged 34 years or older who were literate in Chinese, had no major perinatal complications (e.g., preeclampsia or gestational diabetes requiring intensive management), and had delivered singleton, low-risk infants. This sample size was considered appropriate for preliminary item and exploratory factor analyses because it is in line with standard practices for initial scale validation. Participants were recruited during 1 to 2 month postpartum checkups at both an urban tertiary hospital and a regional community hospital in Taiwan to ensure representation across diverse socioeconomic backgrounds. Mothers of infants with extremely low birth weights (less than 1500 g) were excluded.\u003c/p\u003e \u003cp\u003eAfter item analysis, one item (Item 3; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) was excluded. Exploratory factor analysis was conducted on the remaining 19 items. The Kaiser\u0026ndash;Meyer\u0026ndash;Olkin measure of sampling adequacy was 0.793, and Bartlett\u0026rsquo;s test of sphericity was significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), confirming the suitability of the data for factor analysis. Given the assumed independence of the subscales, factor extraction was performed using exploratory factor analysis with orthogonal (Varimax) rotation.\u003c/p\u003e \u003cp\u003eExploratory factor analysis was conducted by examining eigenvalues and scree plots to identify the underlying factor structure. Factors were retained until a noticeable decrease in eigenvalues was observed. This study adhered to the criterion that retained factors must have eigenvalues greater than 1.0. The analysis yielded five factors, which collectively accounted for 67.548% of the total variance. Items 16 and 20 were excluded because of their low factor loadings (\u0026lt;\u0026thinsp;0.40), which brought the total number of excluded items to three. The resulting prototype version of the Self-Efficacy of Childcare Scale comprised 17 items grouped into 5 factors: responsiveness in parenting, sense of mission related to parenting, parenting support, parenting evaluation, and parenting construction. Item\u0026ndash;total correlation analysis revealed positive correlations between the subscales, with correlation coefficients ranging from r\u0026thinsp;=\u0026thinsp;0.256 to r\u0026thinsp;=\u0026thinsp;0.450, with all significant at the 1% level (two-tailed; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExploratory factor analysis results.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFirst factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecond factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThird factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFourth factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFifth factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCommunality\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFactor 1: Responsiveness in parenting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI plan to continue breastfeeding.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.832\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.744\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo increase breast milk production, I will consume more soup.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.732\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI feel confident in handling any situation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.712\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.602\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI can manage my children in an orderly manner, even when multitasking, without feeling rushed.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.410\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI envision my child\u0026rsquo;s future growth and plan for it diligently.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.453\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFactor 2: Sense of mission related to parenting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAs a mother, my responsibility is to care for my child.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegardless of my fatigue, I can fulfill my role as a mother.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;0.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.686\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI am committed to caring for my children wholeheartedly and ensuring they are in the best possible condition.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.548\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI believe in my ability to provide excellent care for my children.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.647\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI will always strive to provide the best possible care for my children.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.597\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFactor 3: Parenting support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIf I encounter a challenge, I will seek guidance from knowledgeable individuals or professionals to ensure that the information I have on parenting is accurate.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.777\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhen feeling overwhelmed or physically exhausted, I turn to my husband\u0026rsquo;s family and friends for support.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.657\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFactor 4: Parenting evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI am aware of certain child-rearing methods, but I have found them impractical and unfeasible.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.874\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI feel I am still not adept at caring for my children independently and am uncertain about the next steps.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.829\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.746\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhen dissatisfied with my current childcare approach, I feel powerless and reluctant to seek a means of improving it.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.627\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFactor 5: Parenting construction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI learn about how to raise children by observing how my family and friends raise their children.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI gather knowledge on child care from newspapers, magazines, and online sources.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.662\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"4\" nameend=\"c2\" namest=\"c1\" rowspan=\"5\"\u003e \u003cp\u003eCorrelation between item and factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eー\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.256\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.301\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.345\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.408\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eー\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.289\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.450\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.272\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eー\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.403\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.380\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eー\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.350\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eー\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eFactor extraction method: Principal component analysis. Rotation method: Varimax method with Kaiser regularisation.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e**\u003c/sup\u003e Correlation coefficients with a significance level of 1%.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Creation of self-efficacy of childcare scale and analysis of reliability and validity\u003c/h2\u003e \u003cp\u003eFor the main survey, participants completed a comprehensive questionnaire comprising 79 items. These included 10 demographic questions, 17 items from the prototype version of the Self-Efficacy of Childcare Scale, 17 items from Aramaki and Muto\u0026rsquo;s [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Mother\u0026rsquo;s Feeling Scale, 10 items from the Support Network Scale developed by Hung et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], 11 items from Chang\u0026rsquo;s [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] Self-Perceived Health Status Scale, and 14 items from Hu\u0026rsquo;s [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] Breastfeeding Self-Efficacy Scale. Data were collected using a Likert scale between September 2019 and June 2020. The study sample comprised 195 first-time mothers; the inclusion criteria for these mothers matched those used in the preliminary survey. This sample size was considered adequate for conducting robust psychometric analyses, including confirmatory factor analysis (CFA), and is consistent with established recommendations for scale validation studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Analysis\u003c/h2\u003e \u003cp\u003eThe psychometric properties of the scale were examined using multiple statistical analyses. Internal consistency was measured using Cronbach\u0026rsquo;s alpha (α). Construct validity was examined through CFA conducted in SPSS Amos (Version 24), and model fit was determined using the chi-square statistic (χ\u0026sup2;), comparative fit index (CFI), goodness of fit index (GFI), and root mean square error of approximation (RMSEA). Convergent and discriminant validity were evaluated by examining factor loadings, composite reliability (CR), and average variance extracted (AVE) and by comparing the square roots of the AVE with the correlations between factors. To identify constructs related to childcare self-efficacy among older primiparas, Pearson\u0026rsquo;s correlation coefficients were calculated between the total childcare self-efficacy score and related constructs, including mother\u0026rsquo;s feelings, support networks, self-rated health status, and breastfeeding self-efficacy. Criterion validity was evaluated using the Pearson\u0026rsquo;s correlation coefficients between the scale and related constructs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Ethical considerations\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e for the preliminary survey was obtained from the Ethics Committee of the International University of Health and Welfare (Approval No. 18-Io-127) on November 29, 2018. Approval for the main survey was obtained from the Ethics Review Committee of Taoyuan General Hospital, Ministry of Health and Welfare, Taiwan (Approval No. TYGH108016), on September 19, 2019.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e Written informed consent was obtained from all participants prior to their participation in both the preliminary and the main questionnaire surveys. The consent form provided a clear explanation of the study objectives, confidentiality measures, data security protocols, and the participants\u0026rsquo; right to withdraw at any time without consequence. Participants were assured that their decision to participate would not affect them adversely and that all collected data would be used exclusively for research purposes. This study represents a modified section of a doctoral dissertation submitted to the Graduate School of Health and Welfare Sciences at the International University of Health and Welfare.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Demographic characteristics of the study population\u003c/h2\u003e \u003cp\u003eThe demographic characteristics of the 195 first-time mothers aged 34 years or older who participated in the main survey are summarized in the following. The participants had an average age of 37.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.35 years. Among them, 109 (55.9%) were employed, and 154 (79.0%) had attained at least a college-level education. Most of their spouses were employed, with 117 (60.0%) working in a company. Regarding family structure, 117 (60.0%) participants lived in nuclear families. A total of 130 (66.7%) mothers reported that their pregnancy was planned. With respect to the mode of delivery, 80 (41.0%) had a vaginal birth, whereas 115 (59.0%) underwent a cesarean section. In terms of sex preference, 99 (50.8%) participants indicated no preference. In addition, 176 (90.2%) participants reported no abnormalities in their newborns at birth. Regarding infant feeding practices, 116 (59.5%) used mixed feeding, and 67 (34.4%) combined direct breastfeeding with bottle feeding. Finally, 141 (72.3%) participants rated their economic status as \u0026ldquo;satisfactory\u0026rdquo; (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of first-time mothers aged\u0026thinsp;\u0026ge;\u0026thinsp;34 years (n\u0026thinsp;=\u0026thinsp;195).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (55.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86 (44.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege degree or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154 (79.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelow college degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (21.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpouse employment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed (company employee)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117 (60.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (40.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily structure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNuclear family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117 (60.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNonnuclear family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (40.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy planning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlanned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnplanned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMode of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal childbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (41.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e115 (59.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex preference for child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo preference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99 (50.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWith preference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (49.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNewborn health status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo abnormalities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e176 (90.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWith abnormalities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (9.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfant feeding practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116 (59.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect breastfeeding and bottle feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (34.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (6.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-assessed economic status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfactory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141 (72.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnsatisfactory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (27.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2. CFA\u003c/h2\u003e \u003cp\u003eCFA was conducted on the 17-item prototype version of the Self-Efficacy of Childcare Scale developed in the preliminary survey. These 17 items were treated as observed variables in the structural equation model, whereas the 5 identified factors were used as latent variables. The initial CFA was used to evaluate model fit through several indices. The results were as follows: GFI\u0026thinsp;=\u0026thinsp;0.752, adjusted GFI (AGFI)\u0026thinsp;=\u0026thinsp;0.652, CFI\u0026thinsp;=\u0026thinsp;0.737, and RMSEA\u0026thinsp;=\u0026thinsp;0.134. Because the RMSEA was greater than the recommended threshold of 0.08, the model was modified on the basis of modification indices to improve fit. The revisions included the removal of items that significantly reduced the chi-square value and the addition of covariance paths. After modification, the fit indices improved substantially: GFI\u0026thinsp;=\u0026thinsp;0.947, AGFI\u0026thinsp;=\u0026thinsp;0.884, CFI\u0026thinsp;=\u0026thinsp;0.955, and RMSEA\u0026thinsp;=\u0026thinsp;0.080. These revised metrics met or exceeded commonly accepted criteria, supporting the model\u0026rsquo;s overall fit. Although the initial indices fell below standard thresholds, this iterative refinement process indicates the scale\u0026rsquo;s sensitivity to item structure and the importance of careful scale optimization in future similar studies.\u003c/p\u003e \u003cp\u003eAll estimated values and interfactor correlation coefficients, ranging from r\u0026thinsp;=\u0026thinsp;0.37 to r\u0026thinsp;=\u0026thinsp;0.53, were significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating meaningful covariance among the five factors. Additionally, the standardized path coefficients between the latent variables and their corresponding observed variables ranged from 0.60 to 0.96 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Analysis of construct concept validity\u003c/h2\u003e \u003cp\u003eSignificant correlations were observed between the Self-Efficacy of Childcare Scale, its subscales, and the overall scale. As illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, all items met the established criterion, with correlation coefficients equal to or greater than 0.2. Although all correlations exceeded the minimum acceptable threshold, values near the lower end suggest that certain item responses are affected by cultural or contextual factors. This finding warrants further exploration through additional qualitative investigations.\u003c/p\u003e \u003cp\u003eConvergent validity was evaluated using two indicators: CR and AVE. All five factors met the recommended thresholds (CR\u0026thinsp;\u0026ge;\u0026thinsp;0.6, AVE\u0026thinsp;\u0026ge;\u0026thinsp;0.5) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], with CR values ranging from 0.768 to 0.805 and AVE values ranging from 0.622 to 0.674 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConfirmatory factor analysis results.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubscale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem No.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLoading\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCR AVE\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF1:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI plan to continue breastfeeding.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.782 0.644\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo increase breast milk production, I will consume more soup.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF2:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAs a mother, my responsibility is to care for my child.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.811\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.768 0.622\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI believe in my ability to provide excellent care for my children.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF3:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIf I encounter a challenge, I will seek guidance from knowledgeable individuals or professionals to ensure that the information I have on parenting is accurate.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.769\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.805 0.674\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhen feeling overwhelmed or physically exhausted, I turn to my husband\u0026rsquo;s family and friends for support.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF4:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI feel I am still not adept at caring for my children independently and am uncertain about the next steps.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.787 0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI am aware of certain child-rearing methods, but I have found them impractical and unfeasible.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF5:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI learn about how to raise children by observing how my family and friends raise their children.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.772 0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI gather knowledge on childcare from newspapers, magazines, and online sources.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;56.128 (df\u0026thinsp;=\u0026thinsp;25, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), GFI\u0026thinsp;=\u0026thinsp;0.947, AGFI\u0026thinsp;=\u0026thinsp;0.884, CFI\u0026thinsp;=\u0026thinsp;0.955, and RMSEA\u0026thinsp;=\u0026thinsp;0.080.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eα\u0026thinsp;=\u0026thinsp;Cronbach\u0026rsquo;s alpha; CR\u0026thinsp;=\u0026thinsp;Composite Reliability; AVE\u0026thinsp;=\u0026thinsp;Average Variance Extracted.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDiscriminant validity was established by confirming that the square root of the AVE for each factor was greater than the corresponding interfactor correlations. In addition, all correlation coefficients among the five latent variables satisfied the 95% confidence interval criterion of \u0026ne;\u0026thinsp;1. The square roots of the AVE for each factor ranged from 0.789 to 0.821, supporting the presence of discriminant validity (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of confirmatory factor analysis: correlation coefficient between factors.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCriterion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eF5\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.803\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.368***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.424***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.367***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.821\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.444***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.553***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.527***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.806\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.450***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.443***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.413***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.486***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCriterion validity was assessed by examining the correlations between the total score of the Self-Efficacy of Childcare Scale and theoretically related constructs, including support networks, and self-rated health status subscales (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.251 to 0.349, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01; Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The total score of the Self-Efficacy of Childcare Scale was also significantly correlated with the scores of the five identified factors (r\u0026thinsp;=\u0026thinsp;0.654 to 0.725, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Furthermore, a significant but weak positive correlation was found between the total score of the Breastfeeding Self-Efficacy Scale and Factor 1 (responsiveness in parenting) of the Self-Efficacy of Childcare Scale (r\u0026thinsp;=\u0026thinsp;0.238, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). These findings collectively provide evidence supporting the criterion validity of the scale. Collectively, these findings support the construct validity of the Self-Efficacy of Childcare Scale. From a practical perspective, these correlations suggest that the scale may serve as an effective screening tool in postpartum care for identifying older first-time mothers who could benefit from targeted psychosocial support and highlighting areas for future tailored interventions.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCriterion validity of the self-efficacy of childcare scale.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelated constructs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrelation coefficient (r)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMothers\u0026rsquo; feelings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupport networks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-rated health status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreastfeeding self-efficacy scale vs. factor 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Analysis of reliability\u003c/h2\u003e \u003cp\u003eInternal consistency was calculated using Cronbach\u0026rsquo;s α for each of the five factors. The α values were 0.786 for Factor 1, 0.811 for Factor 2, 0.769 for Factor 3, 0.761 for Factor 4, and 0.695 for Factor 5. The overall α coefficient for the scale was 0.855. Factor 5 exhibited a slightly lower α value, which indicates the potential for future refinement of its items. The overall internal consistency was robust, supporting the reliability of the scale.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eCFA indicated that the model demonstrated a robust fit, which supports the construct validity of the scale. However, the number of items for each factor can affect reliability coefficients. Each factor should ideally contain at least three items to ensure robustness [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In the present scale, each factor included only two items, which may have affected the reliability estimates. However, the scale\u0026rsquo;s validity is supported by its high α coefficients and strong factor loadings. Factor loadings of 0.50 or higher are considered acceptable indicators of scale validity [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], and in this study, the α coefficients ranged from 0.695 to 0.811, with factor loadings ranging from 0.60 to 0.96. These results suggest that the scale not only captures breastfeeding-related dimensions but also reflects broader constructs of childcare self-efficacy, supporting its potential application in comprehensive postpartum assessments. Nonetheless, the reliance on self-reported data and the absence of longitudinal follow-up beyond the early postpartum period may have introduced recall or social desirability biases, potentially inflating the observed psychometric strengths. Future studies incorporating objective measures and longer follow-up periods may help clarify these limitations.\u003c/p\u003e \u003cp\u003eThe present study identified several factors associated with maternal self-efficacy in childcare, as measured using the Self-Efficacy of Childcare Scale. Among them, mothers\u0026rsquo; feelings demonstrated a significant but weak positive correlation with the overall self-efficacy score. This finding is consistent those of previous studies conducted by Murai and Ryugo [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and Aramaki and Muto [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] who reported that emotional factors, particularly parenting anxiety, which is a common negative emotional state in the early postpartum period, can affect maternal self-efficacy. Because it can identify mothers experiencing a high level of parenting anxiety, including those in the puerperal period, the current scale can guide the development of targeted support interventions to enhance maternal confidence in childcare. Further supporting its utility, Miyanoki et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] noted an increase in the prevalence of nuclear families in Asia, with an absence of extended family members within a household limiting available support. This shift has led to an increased parenting burden and a high level of parenting anxiety, indicating the current scale\u0026rsquo;s relevance for assessing anxiety in older primiparous women living in nuclear family settings prior to hospital discharge. These findings highlight the importance of early interventions, such as postpartum counseling or emotional regulation programs, to enhance maternal self-efficacy in high-risk groups.\u003c/p\u003e \u003cp\u003eIn addition to emotional factors, the present study identified a significant but weak positive correlation between mothers\u0026rsquo; support networks and their self-efficacy scores. Higher maternal confidence and satisfaction in the first postpartum month are associated with the quality of spousal relationships and the perceived adequacy of social support, particularly with respect to mothers feeling heard and understood when expressing concerns [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Assessing the breadth and quality of mothers\u0026rsquo; support networks, including their familial and broader social relationships, is therefore critical. Because such assessments can be conducted during pregnancy, they can be used to ensure early, tailored interventions are implemented following childbirth. Incorporating such evaluations into routine prenatal care can enable timely implementation of supportive measures designed to enhance perceived social support, thereby improving maternal self-efficacy.\u003c/p\u003e \u003cp\u003eIn the current study, self-rated health status exhibited a significant but weak negative correlation with overall childcare self-efficacy, indicating that better perceived health is associated with lower parenting-related stress and higher self-efficacy. This finding is consistent with that of Chang [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] who identified self-rated health as a crucial factor affecting maternal self-efficacy. Older primiparous women are particularly aware of postpartum health challenges, including fatigue and physical limitations [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In Taiwan, where women undertake substantially more household chores than men do [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], the combined burden of housework and parenting can adversely affect physical and mental well-being. Supporting physical and mental health is thus critical to maintaining favorable self-rated health and enhancing parenting self-efficacy, particularly in older first-time mothers. In clinical settings, midwives may use the scale developed in the present study to evaluate mothers\u0026rsquo; self-rated health status and raise awareness of its role in parenting confidence. More broadly, the findings of the present study support incorporating the scale into structured postpartum intervention programs that address physical health, emotional well-being, and the development of childcare self-efficacy in a coordinated manner.\u003c/p\u003e \u003cp\u003eAlthough correlation analyses were performed, these were conducted solely to evaluate the criterion validity of the scale rather than to explore causal relationships or predictive factors. Future studies using longitudinal designs or multivariate analyses are recommended to further clarify factors associated with childcare self-efficacy.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study validated the Self-Efficacy of Childcare Scale for older primiparous women in Taiwan. The final scale comprises 10 items across 5 subscales: responsiveness in parenting, sense of mission related to parenting, parenting support, parenting evaluation, and parenting construction. Psychometric analysis revealed the scale to have acceptable reliability and construct validity, supporting the use of this instrument to assess childcare self-efficacy in the target population.\u003c/p\u003e \u003cp\u003eA limitation of this study is its use of convenience sampling, which may introduce selection bias and limit the generalizability of the findings. Participants were recruited from a small number of health-care facilities, which may not fully reflect the diverse experiences among older primiparous women across different regions or health-care settings in Taiwan. Future research employing randomized or stratified sampling approaches could improve external validity and broaden the applicability of the scale.\u003c/p\u003e \u003cp\u003eBeyond research applications, this scale could also inform public health policies by serving as a screening and evaluation tool in maternal and child health programs. It could facilitate the early identification of mothers with low childcare self-efficacy, enabling policymakers to design targeted interventions, allocate resources effectively, and support maternal mental health and positive parenting outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the following committees : Ethics Committee of the International University of Health and Welfare, Japan (Approval No. 18-Io-127; Date: November 29, 2018). Ethics Review Committee of Taoyuan General Hospital, Ministry of Health and Welfare, Taiwan (Approval No. TYGH108016; Date: September 19, 2019)\u003cbr\u003e\u0026nbsp;Written informed consent was obtained from all participants prior to participation. The consent form explained the study objectives, confidentiality measures, data security protocols, and participants\u0026rsquo; right to withdraw at any time without consequence.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed during the current study are not publicly available due data protection measures but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interest\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research was part of a PhD thesis at the International University of Health and Welfare,\u0026nbsp;Japan\u0026nbsp;, and received no external funding.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eYu Ming Lai: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Resources; Software; Validation; Visualization; Roles/Writing - original draft; and Writing - review \u0026amp; editing. Yumi Suzuki: Conceptualization; Formal analysis; Methodology; Project administration; Supervision; and Writing - review \u0026amp; editing.\u0026nbsp;All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe author would like to thank the Taiwan older mothers who participated in the study. It is also very grateful for the guidance provided by Professor Keiiti Saito and Professor Midori Kuroda at the Japan International University of Health and Welfare about statistical analysis and questionnaire design.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGender Equality Committee of the Executive Yuan. Republic of China (Taiwan), Gender equality committee. 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Aino J. 2004;17:124\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://cir.nii.ac.jp/crid/1050282676666306304\u003c/span\u003e\u003cspan address=\"https://cir.nii.ac.jp/crid/1050282676666306304\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoshina C. Factors affecting the self-efficacy of elderly primiparas for childcare, International University of Health and Welfare, Master's Thesis, 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMori E. Developing nursing guidelines for childrearing support in Japanese older primiparas, Advanced Research Grant (Cutting-Edge, Next-Generation Research and Development Support Program). Project Number. 2015;LS022:111\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMori E, Maehara K, Iwata H. Childrearing experiences of older primiparas at 4 months postpartum. J Jpn Matern Nurs. 2019;19:23\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Older primipara, Self-efficacy of childcare scale, Scale development, Parenting support","lastPublishedDoi":"10.21203/rs.3.rs-8463765/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8463765/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe average age of women giving birth to their first child has increased. However, no childcare self-efficacy scale specifically designed for older primiparas has been developed.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAims\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo develop the Self-Efficacy of Childcare Scale for older primiparas in Taiwan and to examine its reliability and validity.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study conducted a literature review and extracted content from qualitative longitudinal surveys to clarify the conceptual structure of childcare self-efficacy among older primiparas in Taiwan. An initial item pool was developed and refined through expert review to ensure content validity. A preliminary survey of 140 older primiparas (aged\u0026thinsp;\u0026ge;\u0026thinsp;34 years) was conducted to perform exploratory factor analysis for item reduction and factor identification. A subsequent main survey involving 195 participants was used to confirm the scale structure through confirmatory factor analysis (CFA).\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFactor analysis resulted in a final scale comprising 10 items grouped into five factors: responsiveness in parenting, sense of mission related to parenting, parenting support, parenting evaluation, and parenting construction. The Cronbach\u0026rsquo;s α coefficient for the overall scale was 0.855. CFA revealed good model fit, with a goodness of fit index of 0.947, an adjusted goodness of fit index of 0.884, a comparative fit index of 0.955, and a root mean square error of approximation of 0.080. Significant correlations were observed with related constructs, including mothers\u0026rsquo; feelings, support networks, and self-rated health status.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe Self-Efficacy of Childcare Scale demonstrated acceptable reliability and validity. This scale may serve as a useful assessment and screening tool in obstetric care settings in Taiwan.\u003c/p\u003e","manuscriptTitle":"Development and validation of a self-efficacy of childcare scale for older primiparas in Taiwan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-03 15:56:38","doi":"10.21203/rs.3.rs-8463765/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-13T17:08:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T20:49:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-13T22:32:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169236510887181283547645167584763778147","date":"2026-02-11T17:56:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-11T06:42:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-07T20:08:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-07T06:19:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"314012812415420857016165228417669472611","date":"2026-02-07T05:20:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51470502604948002994886520766492360315","date":"2026-02-06T21:02:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50954621127349524243189131197722004939","date":"2026-02-06T14:11:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"77052389695206581756940104596644502186","date":"2026-01-31T07:39:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"302297978406815220919788010259984052265","date":"2026-01-30T16:04:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-30T07:10:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-27T09:43:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-09T05:41:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-09T02:41:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-01-09T02:33:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f83ecdcb-b380-4b09-91c0-62636833a744","owner":[],"postedDate":"February 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-13T17:24:41+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-03 15:56:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8463765","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8463765","identity":"rs-8463765","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}