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

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 researchdesign. 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 124questions were deemed difficult. Most questions were problematic owing to cultural or linguistic differences (49 questions), while 9questions 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.