Dr. Cindy-Lee Dennis

Cindy-Lee Dennis

Dr. Cindy-Lee Dennis is a Professor in the Lawrence S. Bloomberg Faculty of Nursing and the Faculty of Medicine, Department of Psychiatry at the University of Toronto. She holds a Canada Research Chair in Perinatal Community Health and was recently appointed the Women’s Health Research Chair at Li Ka Shing Knowledge Institute, St. Michael’s Hospital.

She is currently the principal investigator of seven large, multi-site studies and is a co-investigator on twenty-four other research projects concerning maternal, paternal, and infant health outcomes. She holds over $23 million in funding from the Canadian Institutes of Health Research (CIHR) and has over 160 peer-review publications. She is the lead author on eight Cochrane systematic reviews and has provided over 150 invited presentations.

Lastly, she developed the Breastfeeding Self-Efficacy Scale, the most widely used breastfeeding measure in the world that has been translated into over 20 different languages.

Abstract: Co-Parenting: A New Strategy to Include Fathers

The association between parenting and child outcomes makes the family system an ideal setting for public health interventions. There is growing recognition of the importance of co-parenting in facilitating parental adjustment to improve parent, family, and child outcomes. Co-parenting describes how partners relate to each other as they care for their children (Feinberg, 2003). While co-parenting historically referred to parenting arrangements after divorce, the term is now used to describe how parents collaborate in the childrearing context. Co-parenting includes the extent of agreement on childrearing issues, the distribution of child-related labour, the extent to which parents support rather than undermine each other in parenting, and the joint management of childrearing conflict (Feinberg, 2003). Co-parenting differs from relationship quality in that it focuses on the child. Implicit in the definition of co-parenting is the involvement of both mothers and fathers. Traditionally, research to improve child outcomes focused on mothers, but societal changes in gender roles have resulted in increased paternal involvement in parenting with fathers being recognized as contributing uniquely to their child’s development (Ramchandani et al., 2013). Couple-based approaches challenge the idea that men are “support persons” whose role and needs are secondary to that of their partners (Pilkington et al., 2015). Co-parenting emphasizes that while each parent makes a unique contribution to child development, the manner in which parents collaborate in parenting tasks has a unique effect as well. Importantly, seral interventions have been developed that aim to enhance co-parenting. The purpose of this presentation is to review the co-parenting literature as it pertains to the perinatal period and to discuss how it might be used within a breastfeeding context.


Feinberg, M. E. (2003). The internal structure and ecological context of coparenting: a framework for research and intervention. Parenting: Science and Practice, 3(2), 95-131.

Pilkington, P. D., Whelan, T. A., & Milne, L. C. (2015). A review of partner-inclusive interventions for preventing postnatal depression and anxiety. Clinical Psychogist, 19(2), 63-75.

Ramchandani, P. G., Domoney, J., Sethna, V., Psychogiou, L., Vlachos, H., & Murray, L. (2013). Do early father–infant interactions predict the onset of externalising behaviours in young children? Findings from a longitudinal cohort study. Journal of Child Psychology and Psychiatry, 54(1), 56-64

Interview with Dr. Cindy-Lee Dennis
An interview with Dr. Cindy Lee Dennis on co-parenting a new strategy to include fathers which she spoke about at the Medela breastfeeding and lactation symposium. Cindy Lee discusses The association between parenting and child outcomes makes the family system an ideal setting for public health interventions.

Abstract: Breastfeeding Self-Efficacy to Improve Breastfeeding Outcomes: Latest Research and Future Directions

Current World Health Organization/United Nations Children’s Fund (WHO/UNICEF) recommendations for optimal infant feeding includes exclusive breastfeeding for approximately the first 6 months postpartum. Despite decades of research on the barriers to breastfeeding and many efforts to promote and support it, almost every country in the world fails to meet this international recommendation. Recent data suggests only 40% of infants less than 6 months of age worldwide are exclusively breastfed (UNICEF, 2016). If health professionals are to effectively improve low breastfeeding exclusivity rates, they need to reliably assess high-risk women and identify predisposing factors that are amenable to intervention (Dennis and Faux, 1999). One possible modifiable variable is breastfeeding confidence. To promote the conceptual development of breastfeeding confidence, Bandura’s (1977) social cognitive theory was used by Dennis (1999) to develop the breastfeeding self-efficacy concept. Breastfeeding self-efficacy refers to a mother’s confidence in her ability to breastfeed her infant. It is an important variable in breastfeeding outcomes as it predicts: (1) whether a mother chooses to breastfeed or not, (2) how much effort she will expend, (3) whether she will have self-enhancing or self-defeating thought patterns, and (4) how she will emotionally respond to breastfeeding difficulties (Dennis, 1999). Breastfeeding self-efficacy is influenced by four main sources of information: (1) performance accomplishments (e.g., past breastfeeding experiences), (2) vicarious experiences (e.g., watching other women breastfeed), (3) verbal persuasion (e.g., encouragement from influential others such as friends, family, and lactation consultants), and (4) physiological responses (e.g., pain, fatigue, stress, anxiety)(Bandura, 1977; Dennis, 1999). As such, health professionals may enhance a mother’s breastfeeding confidence by altering these sources of self-efficacy information. To measure breastfeeding confidence the Breastfeeding Self-Efficacy Scale (BSES) was developed and psychometrically tested (Dennis and Faux, 1999). Replicating this original research, further methodological studies have been conducted internationally and suggest BSES scores in the early postpartum period predict breastfeeding duration and exclusivity at 4, 6, 8, and 16 weeks postpartum. This work provides evidence that the BSES may be an internationally applicable, reliable, and valid measure to assist health professionals in caring for breastfeeding women. The aim of this presentation is to review the latest research related to breastfeeding self-efficacy and to discuss future directions and clinical implications.


Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84,191-215

Dennis, C.L. (1999). Theoretical underpinnings of breastfeeding confidence: A self-efficacy framework. Journal of Human Lactation, 15(3), 1–7.

Dennis, C. L., & Faux, S. (1999). Development and psychometric testing of the breastfeeding self-efficacy scale. Research in Nursing & Health, 22(5),399-409.

UNICEF (2016). Infant and young child feeding: Global database. Retrieved from https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/

Dr. Cindy-Lee Dennis: Self-efficacy
Dr. Cindy Lee Dennis talks about her presentation at the Medela Breastfeeding and Lactation Symposium about breastfeeding self-efficacy to improve breastfeeding outcomes. She discusses the idea to promote the conceptual development of breastfeeding confidence using social cognitive theory to develop the breastfeeding self-efficacy concept.