Cultural and linguistic applicability of the English PEDS tools in a low-income community: A caregiver perspective

Abstract

Background. Regular developmental surveillance using structured developmental screening tools is a proven way to effectively identify developmental delays and disabilities. Most screening tools are developed and standardised in high-income countries and then adapted and translated for low-and middle-income countries. However, cultural differences and viewpoints make it challenging to translate and adapt developmental screening tools for low-income communities. Objectives. To determine caregivers’ perspectives on linguistic and cultural appropriateness of the Parents’ Evaluation of Developmental Status (PEDS) and the PEDS: Developmental Milestones (DM) as a first step in the adaptation process for low-income communities in South Africa. Method. Participants (N=102) were selected using convenience sampling at an immunisation clinic. We employed a survey research design. Quantitative data were analysed using descriptive statistics and qualitative survey feedback survey was analysed using data-driven inductive methodology. Results. On the PEDS questionnaire, 38.2% of participants indicated the term ‘development’ on question 1 was not suitable; and 51% preferred the phrase ‘sometimes worry’ more than the phrase ‘have any concerns’ for questions 2-9. On the PEDS:DM, 58 of the 124 questions were deemed difficult. Most questions were problematic owing to cultural or linguistic differences (49 questions), while 9 questions were too difficult for the child’s age. The expressive language developmental domain had the most challenges. Conclusion. The present study relied on robust community participation, enabling community-led adaptation of the PEDS tools. Items on the tools were viewed solely from a community perspective, empowering the community to be ‘experts’ in this process, ensuring greater contextual relevance and applicability of the tools, as well as generalisability to similar low-income communities.