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Survey of Well-being of Young Children-Brazilian version: from transcultural adaptation to creation of an app to screen for developmental and behavioral problems

Thu, March 23, 3:15 to 4:45pm, Salt Palace Convention Center, Floor: 1, Grand Ballroom E

Abstract

Promoting child development is a priority of the National Policy for Child Health in Brazil. Nevertheless, Brazilian professionals still struggle to assess child development due to the scarcity of tools that are culturally adapted and validated to our context. Aiming to fill this gap, we conducted a series of studies to adapt and build evidence on the SWYC-BR’s validity as a screening for child developmental and behavioral problems and risk factors in the family context and to establish cut-offs to interpret the Developmental Milestones (DM) questionnaire. Based on the SWYC-BR forms, we created the TEDI (screening and stimulation of child development, in Portuguese), an app for mobile devices to support health professionals during child developmental and behavioral assessments and stimulation. More than 1000 typical Brazilian children from different contexts aged 1 to 65 months and their parents were involved in the SWYC-BR validation process. In general, they were recruited from public health services and daycare centers. The research involved health professionals, such as pediatricians, physical therapists, occupational therapists, and non-specialized professionals, such as community health agents. The cross-cultural adaptation included the translation into Brazilian Portuguese, back-translation into American English (original language), evaluation of the referential and general equivalence, cognitive interviews, and pre-test versions. Internal consistency, convergent and construct validity, and the factorial load of the DM´s items were examined. The concurrent validity of the DM questionnaires was tested against the ASQ-3. The DM normative study followed the original methods and used Item Response Theory (IRT) to examine the items’ validity. The clinical threshold for suspected developmental delay was set at 85% of the DM-SWYCBR mean score for each age. Convergent and construct validity and reliability of the Baby and Pediatric Symptoms Checklist (BPSC and PPSC) questionnaires were also tested. Acceptability and test-retest reliability was conducted in the primary health care context. To create the app, firstly, we submitted the algorithms to a child development specialists panel. Following this step, we performed a usability test with 25 health professionals working in different contexts. Afterward, a test-retest analysis was conducted with 100 mothers to determine the DM questionnaire reliability using audiovisual support (vignettes). The SWYC-BR questionnaires have shown satisfactory measurement properties, such as internal consistency, test-retest reliability, and validity. The normative study showed that Brazilian cut-off points were quite similar to the North American in most ages. However, differences were bigger for older children, which may have clinical relevance. Regarding the TEDI, the validation process provided scientific consistency to the app, which was improved step by step, generating more than 30 versions up to the final version. Developmental assessment tools adaptation and validation processes are long and complex but absolutely necessary to support effective child development assessment, ensuring timely intervention and rational use of the resources. The SWYC-BR satisfactory psychometric properties support its use in clinical and research contexts. Furthermore, the TEDI app follows an international tendency to use validated electronic tools to support health professionals' assessments and clinical decisions.

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