Validation of the Pictorial Pediatric Symptom Checklist – Filipino Version for the Psychosocial Screening of Children in a Low-income Urban Community

Abstract

Rationale. The timely identification of children with psychosocial problems is very important in facilitating early intervention. Detection of these children in the community setting requires thedevelopment of an easy-to-use screening tool that can be used by community health workers.Objective. To develop a valid and reliable screening tool that can be easily used by community health workers for the detection of psychosocial problems in Filipino children. Specifically, 1) To develop a Filipino version of the Pictorial Pediatric Symptom Checklist (PPSC) for use by community health workers; and 2) To culturally validate the PPSC-Filipino version in a low-income urban community.Methods. This study consisted of three phases: Phase 1 (Exploratory Study) consisted of focus group discussions and key informant interviews for content validation. Phase 2 (Questionnaire Development) involved refinement of the Filipino translation of the PPSC. In Phase 3 (Actual Survey), the PPSC was administered by health workers to 127 primary caregivers of children aged 4 to 7 years residing in a low-income community in Pandacan, Manila. Data gathered were subjected to reliability testing andfactor analysis for construct validation. Chi-square analyses were done to determine the association of sociodemographic factors to overall PPSC results.Results. Construct and content validity were confirmed. The Filipino PPSC showed high internal consistency (Cronbach’s alpha 0.89). Factor analysis resulted in three new domains: 1) Attention &Externalizing Problems, 2) Internalizing Problems, and 3) School & Learning Problems. Among the 127 children screened, 24 (18.9%) were positive for psychosocial problems. Externalizing behaviors (fighting, rule-breaking, teasing) dominated among those who screened positive. The child’s age and number of siblings were the factors significantly associated with the overall PPSC results.Conclusions. The Pictorial Pediatric Symptom Checklist-Filipino Version is a valid and reliable tool in screening for psychosocial problems in children aged 4 to 7 years old residing in a lowincome urban community. Administration by community health workers is feasible and its use in the community setting is particularly relevant since many cases of psychosocial disorders remain undetected.