Community perspectives on developmental screening of American Indian and Alaska Native children

Children are highly regarded and treasured as the future of American Indian and Alaska Native (AIAN) communities. Developmental disorders, however, are more frequently undiagnosed and untreated in AIAN children compared to others in the United States. Developmental screening can help communities ensure that their children reach their full potential, but lack of culturally sensitive and valid screening measures complicates screening among AIAN children. This can, in turn, delay access to early intervention and undermine the ability of AIAN communities to support children's optimal development. This study explored families' and professionals' perceptions of screening systems and processes in AIAN communities and to identify gaps and opportunities. A total of 53 interviews and 23 focus groups were conducted with 157 parents and early childcare professionals in four AIAN communities. A conceptual framework to describe systems of screening for young children was developed by AIAN early childhood program partners and early childhood researchers working together on a Tribal Early Childhood Research Center Community of Learning; this framework guided study design and interview guides. Transcripts were coded for themes in alignment with the conceptual framework; 13 key themes and 81 subthemes were identified. Findings are discussed in terms of implications for enhancing screening efforts in Tribal communities.

Measurement properties of the Physical Literacy Assessment for Youth (PLAY) Tools

The Physical Literacy Assessment for Youth (PLAY) Tools are a suite of tools to assess an individual's physical literacy. The purpose of this study is to examine the psychometric properties of the PLAY Tools, including inter-rater reliability, internal consistency, validity and the associations between the tools. In this study, 218 children and youth (aged 8.4 to 13.7 years) and a parent/guardian completed the appropriate physical literacy assessments (i.e., PLAYbasic, PLAYfun, PLAYparent and PLAYself) and the Bruiniks-Oseretsky Test of Motor Proficiency (BOT-2). Inter-rater reliability for PLAYfun was excellent (intraclass correlation coefficient = 0.94). The PLAYbasic, PLAYfun total, running and object control scores, and PLAYparent motor competence domain were higher in males than females, and PLAYfun locomotor skills were lower in males than females (p < 0.05). Age was positively correlated with PLAYbasic and PLAYfun (r = 0.14-0.32, p < 0.05). BOT-2 was positively correlated with PLAYfun and PLAYbasic (r = 0.19-0.59, p < 0.05). PLAYbasic is a significant predictor of PLAYfun (r² = 0.742, p < 0.001). PLAYfun, PLAYparent and PLAYself were moderately correlated with one another. PLAYfun, PLAYparent and PLAYself demonstrated acceptable internal consistency (α = 0.74-0.87, ω = 0.73-0.87). The PLAY Tools demonstrated moderate associations between one another, strong inter-rater reliability and good construct and convergent validity. Continued evaluation of these tools with other populations, such as adolescents, is necessary. Novelty: In school-age children, the PLAY Tools demonstrated strong inter-rater reliability, moderate associations with one another, acceptable internal consistency and good construct and convergent validity. The results suggest that that PLAY Tools are an acceptable method of evaluation for physical literacy in school-age children.

Monitoring maternal and newborn health outcomes globally: a brief history of key events and initiatives

OBJECTIVE

Over time, we have seen a major evolution of measurement initiatives, indicators and methods, such that today a wide range of maternal and perinatal indicators are monitored and new indicators are under development. Monitoring global progress in maternal and newborn health outcomes and development has been dominated in recent decades by efforts to set, measure and achieve global goals and targets: the Millennium Development Goals followed by the Sustainable Development Goals. This paper aims to review, reflect and learn on accelerated progress towards global goals and events, including universal health coverage, and better tracking of maternal and newborn health outcomes.

METHODS

We searched for literature of key events and global initiatives over recent decades related to maternal and newborn health. The searches were conducted using PubMed/MEDLINE and the World Health Organization Global Index Medicus.

RESULTS

This paper describes global key events and initiatives over recent decades showing how maternal and neonatal mortality and morbidity, and stillbirths, have been viewed, when they have achieved higher priority on the global agenda, and how they have been measured, monitored and reported. Despite substantial improvements, the enormous maternal and newborn health disparities that persist within and between countries indicate the urgent need to renew the focus on reducing inequities.

CONCLUSION

The review has featured the long story of the progress in monitoring improving maternal and newborn health outcomes, but has also underlined current gaps and significant inequities. The many global initiatives described in this paper have highlighted the magnitude of the problems and have built the political momentum over the years for effectively addressing maternal and newborn health and well-being, with particular focus on improved measurement and monitoring.

A new measurement of an indirect measure of condom use and its relationships with barriers

One of the challenges facing researchers in the domain of human immunodeficiency virus prevention is the assessment of condom use in an unbiased self-reported manner. The current study presents the development and preliminary validation of an indirect condom use test (I-CUTE), designed to assess condom use tendencies and to overcome self-report biases. Two samples were included using correlational designs. In sample 1, 88 students from European university completed the I-CUTE with questionnaires of condom use barriers, social desirability, and condom use negotiation self-efficacy. In sample 2, 212 students from sub-Saharan universities completed the I-CUTE with questionnaires of condom use barriers and knowledge. The I-CUTE included 17 pictures of human figures in relation to condom use, where participants had to choose one of the four a-priori given sentences reflecting the figures’ thoughts. This represented a semi-projective, yet standardized test. In sample 1, I-CUTE scores were inversely related to barriers, positively correlated with condom use negotiation self-efficacy and unrelated to social desirability. In sample 2, I-CUTE scores were inversely related to barriers and unrelated to knowledge scores. In a multiple regression, condom use barriers had a unique contribution to explaining variance in I-CUTE scores, beyond the contribution of background variables and knowledge. These results support the preliminary reliability and validity of the I-CUTE tool in a variety of cultures, and reveal its lack of bias by social desirability and the importance of condom use barriers in condom use tendencies.

The Paediatric Admission Quality of Care (PAQC) score: designing a tool to measure the quality of early inpatient paediatric care in a low-income setting

Background

Evaluating clinician compliance with recommended steps in clinical guidelines provides one measure of quality of process of care but can result in a multiplicity of indicators across illnesses, making it problematic to produce any summative picture of process quality, information that may be most useful to policy‐makers and managers.

Objective

We set out to develop a clinically logical summative measure of the quality of care provided to children admitted to hospital in Kenya spanning the three diagnoses present in 60% or more of admissions that would provide a patient‐level measure of quality of care in the face of comorbidity.

Methods

We developed a conceptual model of care based on three domains: assessment, diagnosis and treatment of illnesses. Individual items within domains correspond to recommended processes of care within national clinical practice guidelines. Summative scores were created to reduce redundancy and enable aggregation across illnesses while maintaining a clear link to clinical domains and our conceptual model. The potential application of the score was explored using data from more than 12 000 children from eight hospitals included in a prior intervention study in Kenya.

Results

Summative scores obtained from items representing discrete clinical decision points reduced redundancy, aided balance of score contribution across domains and enabled direct comparison of disease‐specific scores and the calculation of scores for children with comorbidity.

Conclusion

This work describes the development of a summative Paediatric Admission Quality of Care score measured at the patient level that spans three common diseases. The score may be an efficient tool for assessing quality with an ability to adjust for case mix or other patient‐level factors if needed. The score principles may have applicability to multiple illnesses and settings. Future analysis will be needed to validate the score.