Abstract
BackgroundAdaptation of standardized early child development (ECD) assessments to low- and middle-income countries can be challenging because of culture-specific factors relating to language, content, context, and tool administration, and because the reliance of these tests on specialist healthcare professionals limits their scalability in low resource settings.MethodsWe report the cross-cultural adaptation of an international, standardized ECD instrument, the INTERGROWTH-21st Project Neurodevelopment Assessment (INTER-NDA), measuring cognitive, language, motor and behavioural outcomes in 2-year-olds, from a UK-based English-speaking population to the English-speaking Caribbean. Children aged 22-30 months were recruited from a pre-existing randomized controlled neurodevelopment intervention study in Grenada, West Indies.ResultsEight of 37 INTER-NDA items (22%) were culturally and linguistically adapted for implementation in the Caribbean context. Protocol adherence across seven newly-trained non-specialist child development assessors was 89.9%; six of the seven assessors scored ≥80%. Agreement between the expert assessor and the non-specialist child development assessors was substantial (κ = 0.89 to 1.00 (95% CI [0.58, 1.00]). The inter-rater and test-retest reliability for non-specialist child development assessors was between κ = 0.99 -1.00 (95% CI [0.98, 0.99]) and κ = 0.76 - 1.00 (95% CI [0.33, 1.00]) across all INTER-NDA domains.ConclusionsThe current study provides evidence to support the use of the adapted INTER-NDA by trained, non-specialist assessors to measure ECD prevalence in the English-speaking Caribbean. It also provides a methodological template for the adaptation of child developmental measures to cultural and linguistic contexts that conform to the cultural standards of the countries in which they are utilized to aid in the measurement of neurodevelopmental impairments (NDIs) in a variety of global clinical settings.
Highlights
Adaptation of standardized early child development (ECD) assessments to low- and middle-income countries can be challenging because of culture-specific factors relating to language, content, context, and tool administration, and because the reliance of these tests on specialist healthcare professionals limits their scalability in low resource settings
Epidemiological data on normative child development are sparse or non-existent in many parts of the world, in those areas where children are most at risk [3]. This creates challenges for early child development (ECD) surveillance in low and middle-income countries (LMICs), where ECD outcomes in children from disparate geographical and/or cultural contexts are evaluated using instruments that have not been subjected to a rigorous standardization, adaptation and cultural-customization process for use in these settings
The current study addresses this methodological gap in ECD measurement in the Caribbean by, for the first time, (1) adapting and culturally customizing a rapid, multi-dimensional, international, standardized ECD instrument, The INTERGROWTH-21st Neurodevelopment Assessment (INTERNDA), for the measurement of cognitive, motor, language and behavioral outcomes in young Caribbean children, (2) comparing the psychometric properties of the adapted to the original tool and (3) evaluating the ability of non-specialist child development assessors to administer and score the adapted version of the INTER-NDA
Summary
Adaptation of standardized early child development (ECD) assessments to low- and middle-income countries can be challenging because of culture-specific factors relating to language, content, context, and tool administration, and because the reliance of these tests on specialist healthcare professionals limits their scalability in low resource settings. Epidemiological data on normative child development are sparse or non-existent in many parts of the world, in those areas where children are most at risk [3] This creates challenges for early child development (ECD) surveillance in LMICs, where ECD outcomes in children from disparate geographical and/or cultural contexts are evaluated using instruments that have not been subjected to a rigorous standardization, adaptation and cultural-customization process for use in these settings. This is significant in ECD assessments because social, cultural and language-related factors can adversely affect a child’s understanding of a test item and his/her subsequent performance on the ECD measure [30]. The life-course and public health consequences of either outcome are significant
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