Feasibility and acceptability of implementing the Global Scales for Early Development (GSED) package for children 0-3 years across three countries.
Author:
Merchant Ambreen Nizar1ORCID, Kaur Raghbir2, McCray Gareth3, Cavallera Vanessa4, Weber Ann5, Gladstone Melissa6, Janus Magdalana7, Nisar Imran1, Kariger Patricia8, Sazawal Sunil9, Dutta Arup9, Zhang Yunting10, Mercadante Mariana Pacifico11, Zongo Arsene12, Schonbeck Yvonne13, Dua Tarun14, Eekhout Iris13, Tofail Fahmida15, Black Maureen16, Baqui Abdullah17, McCoy Dana18, Ahmed Salahuddin15, Begum Farzana1, Anago Romuald Kouadio E19, Brentani Alexandra20, Jiang Fan10, Detmar Symone13, Maillard Michelle Perez4, Waldman Marcus21, Buuren Stef van22, Raikes Abbie23, Hepworth Katelyn23, Codina Marta Rubio24, Akhtar Shirina15, Jehan Fyezah1, Khanum Rasheda17, Naqvi Hassan1, Asif Abrarul Haque15, Mehmood Junaid1, Afzal Sidra1, Lancaster Gillian3
Affiliation:
1. Aga Khan University Medical College Pakistan 2. WHO: World Health Organization 3. Keele University School of Medicine 4. World Health Organization 5. University of Nevada Reno 6. University of Liverpool 7. McMaster University 8. University of California Berkeley School of Public Health 9. Center for Public Health Kinetics, CPHK Global, Pemba, Zanzibar, Tanzania 10. Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine 11. University of Sao Paulo: Universidade de Sao Paulo 12. IPA Cote d Ivoire, Innovations for Poverty Action, Adibjan 13. Netherlands Organization for Applied Scientific Research: TNO 14. World Health Organisation: World Health Organization 15. International Centre for Diarrhoeal Disease Research Bangladesh 16. University of Maryland School of Medicine 17. Johns Hopkins Bloomberg School of Public Health: Johns Hopkins University Bloomberg School of Public Health 18. Harvard Graduate School of Education 19. IPA Cote d Ivoire 20. University of Sao Paulo State: Universidade Paulista 21. University of Nebraska Medical Center College of Public Health 22. University of Utrecht: Universiteit Utrecht 23. : University of Nebraska Medical Center College of Public Health 24. Inter-American Development Bank
Abstract
Abstract
Background
To assess the neurodevelopment of children under three years, a multinational team of subject matter experts (SMEs) led by the World Health Organization (WHO) developed the Global Scales for Early Development (GSED). The measures include 1) a caregiver-reported short form (SF), 2) a directly administered long form (LF), and 3) a caregiver-reported psychosocial form (PF). The feasibility objectives of this study in Bangladesh, Pakistan, and the United Republic of Tanzania were to assess 1) the study implementation processes, including translation, training, reliability testing, and scheduling of visits, and 2) the comprehensibility, cultural relevance, and acceptability of the GSED measures and the related GSED tablet-based application (App) for data collection for caregivers, children, and assessors.
Methods
In preparation for a large-scale validation study, we implemented several procedures to ensure that study processes were feasible during the main data collection and that the GSED was culturally appropriate, including translation and back translation of the GSED measures and country-specific training packages on study measures and procedures. Data were collected from at least 32 child-caregiver dyads, stratified by age and sex, in each country. Two methods of collecting inter-rater reliability data were tested: live in-person versus video-based assessment. Each country planned two participant visits, the first to gain consent, assess eligibility, and begin administration of the caregiver-reported GSED SF, PF, and other study measures, and the second to administer the GSED LF directly to the child. Feedback on the implementation processes was evaluated by in-country assessors through focus group discussions (FGDs). Feedback on the comprehensibility, relevance, and acceptability of the GSED measures from caregivers was obtained through exit interviews in addition to the FGD of assessors. Additional cognitive interviews were conducted during administration to ensure comprehension and cultural relevance for several GSED PF items.
Results
The translation/back translation process identified items with words and phrases that were either mistranslated or did not have a literal matching translation in the local languages, requiring rewording or rephrasing. Implementation challenges reiterated the need to develop a more comprehensive training module covering GSED administration and other topics, including the consent process, rapport building, techniques for maintaining privacy and preventing distraction, and using didactic and interactive learning modes. Additionally, it suggested some modifications in the order of administration of measures. Assessor/supervisorconcurrent scoring of assessments proved to be the most cost-effective and straightforward method for evaluating inter-raterreliability. Administration of measures using the App was considered culturally acceptable and easy to understand by most caregivers and assessors. Mothers felt anxious about several GSED LF items assessing neonates’ motor skills. Additionally, some objects from the GSED LF kit (a set of props to test specific skills and behaviors) were unfamiliar to the children, and hence, it took extra time for them to familiarize themselves with the materials and understand the task.
Conclusion
This study generated invaluable information regarding the implementation of the GSED, including where improvements should be made and where the administered measures' comprehensibility, relevance, and acceptability needed revisions. These results have implications both for the main GSED validation study andthe broader assessment of children’s development in global settings, providing insights into the opportunities and challenges of assessing young children in diverse cultural settings.
Publisher
Research Square Platform LLC
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