Me and My Baby: The measurement properties and acceptability of a new mother-infant bonding tool designed for use in a universal healthcare setting in the UK.

Publication authors

Tracey Bywater, Sarah Louise Blower, Abigail Dunn, Charlotte Endacott, Karen Smith, and Paul Tiffin


The focus of this study is to evaluate the measurement properties and acceptability of a self-report co-developed tool which seeks to assess maternal-infant bonding, defined as the affective (feelings and attitudes) component of the mother’s relationship to the infant. The decision to focus on a self-report tool of affective bond to the infant has been made for both theoretical and practical reasons (explored below). We are restricting our interest to biological mothers of infants as we are developing a tool for use initially with health visiting services. Following appropriate validation and reliability appraisal the tool may be used with fathers and other primary caregivers in the future.

Aims and objectives:
To address previous paucity and quality of available tools to assess parent (mother)-infant relationship, specifically bonding, by developing a measure for use in research as well as universal health settings as part of a referral pathway, and potentially clinical practice, to identify dyads in need of additional support or interventions. The research objectives are to:
1. Pilot MaMB in universal health services to evaluate its feasibility for use in routine practise;
2. To explore data and to determine the item and test properties in relation to reliability in terms of both internal consistency and test information; and
3. To revise MaMB as appropriate in the light of the results of our psychometric analysis.
Research questions
RQ1: What are the measurement properties of the MaMB? This study is specifically interested in two properties; construct validity and internal consistency.
a) What is the most plausible dimensionality (factor structure) of the MaMB?
b) Does the scale (or subscales if applicable) of the MaMB demonstrate acceptable levels of internal consistency?
c) Using item response modelling, do the items demonstrate an acceptable fit to the Rasch model, implying that the summed scores from the instrument can be used as a ‘sufficient summary statistic’?
d) What is the test information curve for the test (or putative scales), and where might a potential cut-off score be best placed that most accurately differentiates between two groups of test-takers?
RQ2: Is the MaMB acceptable to mothers of infants (aged 6-8 weeks) and Health Visitors (HVs) when administered in a universal healthcare setting?
a) As a proportion of all eligible dyads, how many complete the MaMB?
b) What are the reasons given for non-completion?
c) Are there any significant differences in the key characteristics of completers and non-completers?
d) Are the free text boxes completed by parents and what information is being recorded/reported in them?

A cross-sectional design will be applied. The MaMB will be implemented universally (in two sites in North East England) with all mothers during a routine health visitor contact.
The administration of the tool will be conducted by HVs during the 6-8 week routine contact following completion of the core mandated elements of the visit.
Anonymised data will be extracted from the SystmOne template and shared with the study team for analysis.
In order to construct a sample large enough to support the analysis of psychometric properties we propose a sample of 673 constructed over 2.5 months. The overall sample would comprise a further 673 non-completers (total n=1346).
Analyses will include; Parallel analysis followed by an exploratory factor analysis (EFA) and subsequent confirmatory factor analyses (CFA). Item response modelling and theory (IRT) will also be applied.
acceptability of the tool will include exploring completion rates and differences between ‘completes’ and ‘non-completes’ using key demographic characteristics – age, parity, ethnicity, English as an additional language. All data is anonymous. Free-text comments will be analysed using thematic analysis.
Data sharing agreements are in place and data management will be compliant with the General Data Protection Regulation (GDPR) and University of York data management policies.
This project has received ethical approval: REC reference: 20/SC/0266 IRAS project ID: 273708
The protocol, which details in full the information above, has been submitted for publication.