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Breast milk is known as the best and most complete source of nutrition for newborns and children in different cultures. In the relevant literature, different ages are suggested for weaning (1). However, the need for a return to work, (2), as well as illness and disease of the mother or child, cultural contexts, misconceptions, and the level of parents’ awareness may affect the age for a child for weaning (3-5). Most mothers generally receive the necessary education and consultation about breastfeeding but not weaning (6). Mothers’ conceptions about weaning are influenced by their experiences and cultural beliefs, which also influence the method of weaning. Therefore, weaning is performed in different ways and is affected by numerous factors including the education level, along with economic, social, and cultural factors (7). Cultural factors, especially, play an important role in this respect (8). Some studies showed that mothers employ different methods for weaning such as changing the breasts’ appearance or using chemicals and medicines for changing the taste of breast milk (8, 9). Using such methods, which have cultural roots, may have physical and psychological consequences for the child such as trauma, regressive behaviors, the deprivation of maternal emotions and love, anxiety, restlessness, and sleeping disorders, as well as the feelings of less intimacy, (11) the loss of feelings, sadness, and guilt in mothers (12,13). Despite these consequences, few studies point to the role of cultural beliefs in the selection of a weaning method (10). Additionally, some studies examined the qualitatively cultural beliefs of parents, especially mothers about weaning (14,15). Abstract Objectives: This study was designed to investigate the role of cultural beliefs on weaning. Therefore, the obtained results can be used for health policymakers who design strategies to prevent physical and mental damage to mothers and their children. The main objective of this study was to design a questionnaire probing the role of cultural beliefs on weaning. Materials and Methods: The sequential combination exploratory mixed methods design was used to develop the questionnaire format in two sections. The qualitative section was designed to probe the role of cultural beliefs on weaning, which included a literature and related tools review and fieldwork (semi-structured interviews with mothers). Twenty-two studies were examined in the literature review and 14 mothers were selected and interviewed by a purposive sampling technique. The interviews continued up to data saturation as well. In addition, data analyses for both steps were conducted using conventional and textual content analyses. The quantitative section was a methodology study that was accomplished in two parts. Questionnaire items were formed using the data and item pool obtained from the first part. Finally, the psychometric properties of the questionnaire were checked using face, content, and construct validity, followed by probing reliability using Cronbach’s alpha reliability in the second part. Results: Qualitative data analysis results were organized according to the foundational issues regarding the need for weaning, attitude toward weaning, awareness about weaning, society’s culture, health literacy, self-action, others’ experiences, professional help, family members’ support, and the outcomes. The item pool was formed using literature reviews and interviews. A 49-item questionnaire was developed after the completion of the psychometric process. The Kaiser-Meyer-Olkin Index of Sampling Adequacy and Bartlett’s test of sphericity showed good results in this regard. Five components from the exploratory content analysis encompassing contexts, solutions, searching for help, maternal outcomes, and child-related outcomes demonstrated a 62.112% variance. Further, the Cronbach’s alpha was 0.88 and the interclass correlation coefficient was 0.89 based on responses to the items over two administrations of the questionnaire (P < 0.001). Thus, these results showed a high level of tool stability. Conclusions: For this study, a questionnaire was developed for understanding the role of cultural beliefs on weaning. It can be used for educational, research, and treatment purposes as a tool with appropriate validity and reliability, as well as short, easy, and grammatically simple items. Eventually, the questionnaire is useful for examining mothers’ false beliefs about weaning and their educational needs since false beliefs could cause destructive and health-threatening behaviors.

Questionnaire on Mothers’ Cultural Beliefs About Weaning: Development and Psychometric Evaluation