RESUMEN
BACKGROUND: 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. METHODS: We 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. RESULTS: Eight 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. CONCLUSIONS: The 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.
Asunto(s)
Desarrollo Infantil , Lenguaje , Niño , Preescolar , Etnicidad , Humanos , Lactante , Reproducibilidad de los Resultados , Indias OccidentalesRESUMEN
Many young children in low- and middle-income countries (LMICs) are at risk of developmental delays. Early child development (ECD) interventions have been shown to improve outcomes, but few interventions have targeted culturally normative violence such as corporal punishment (CP). We partnered with an existing community-based ECD organization in the LMIC of Grenada to implement a parallel controlled-trial single-blind responsive caregiving intervention that educates parents about the developing brain and teaches alternatives to corporal punishment while building parental self-regulation skills and strengthening social-emotional connections between parent and child. Parents and primary caregivers with children under age two were eligible. Allocation to the intervention and waitlist control arms was unblinded and determined by recruitment into the program. Neurodevelopment was assessed by blinded testers when each child turned age two. Primary comparison consisted of neurodevelopmental scores between the intervention and waitlist control groups (Clinicaltrials.gov registration # NCT04697134). Secondary comparison consisted of changes in maternal mental health, home environment, and attitudes towards CP. Children in the intervention group (n = 153) had significantly higher scores than children in the control group (n = 151) on measures of cognition (p = .022), fine motor (p < .0001), gross motor (p = .015), and language development (p = .013). No difference in secondary outcomes, including CP, was detected.
Muchos niños en países de renta media y baja corren el riesgo de sufrir retrasos en el desarrollo. Las intervenciones en periodos tempranos del desarrollo infantil pueden mejorar sus resultados, pero pocas de ellas abordan la violencia culturalmente normativa, como el castigo corporal. En asociación con una organización comunitaria que trabajaba en el ámbito del desarrollo infantil temprano en Granada se llevó a cabo una intervención paralela de parentalidad responsiva mediante un ensayo controlado de simple-ciego con el fin de educar a los padres sobre el cerebro en desarrollo y alternativas al castigo corporal, a la vez que les enseñaban destrezas de autorregulación y se fortalecían los vínculos socioemocionales entre padres e hijos. Para ello se eligieron padres y cuidadores primarios de niños menores de dos años. La asignación a los grupos de intervención y lista de espera de control no fue ciega, estando determinada por el reclutamiento al programa. El desarrollo neurológico fue evaluado a ciegas cuando el niño cumplía dos años. La comparación primaria constaba de puntuaciones en neurodesarrollo entre los grupos intervención y lista de espera de control (Clinicaltrials.gov registration # NCT04697134). La comparación secundaria constaba de cambios en la salud mental materna, entorno del hogar y actitudes hacia el castigo corporal. Los niños en el grupo de intervención (n = 153) tenían puntuaciones significativamente superiores a las de los niños del grupo control (n = 151) en las medidas de cognición (p = .022), motricidad fina (p < .0001), motricidad gruesa (p = .015) y desarrollo del lenguaje (p = .013). No se encontraron diferencias en los resultados secundarios, entre los que se incluía el castigo corporal.