Screening Instruments for Developmental and Behavioral Concerns in Pediatric Hispanic Populations in the United States: A Systematic Literature Review
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Published on: July 18, 2020
Stacey L Bevan1, Jianghong Liu1,2, Kate E Wallis3,4
1School of Nursing, University of Pennsylvania, Philadelphia, PA.
Insights
Spanish-language developmental screening tools may not be psychometrically valid for Hispanic families due to language and cultural differences. Further validation is essential to ensure accurate identification of developmental delays in all children.
Area of Science:
- Pediatric Health
- Developmental Psychology
- Public Health
Background:
- Racial and ethnic disparities persist in identifying developmental and behavioral concerns in U.S. children.
- Early identification of developmental delay is crucial for timely intervention and prevention in pediatric care.
- The psychometric validity of Spanish-language screening instruments in clinical settings remains under-examined.
Purpose of the Study:
- To systematically review the literature on developmental and behavioral instruments administered to Hispanic caregivers.
- To investigate variations in implementation influenced by language and cultural factors.
Main Methods:
- A systematic literature review was conducted using PubMed and PsycINFO.
- Searched for articles published between January 1, 2006, and December 12, 2017.
- Eleven studies met the inclusion criteria after abstract, full-text review, and critical appraisal.
Main Results:
- Five instruments screened Hispanic/Spanish-speaking caregivers of children under 6.
- No instruments demonstrated validity and reliability beyond their original Spanish translation.
- Language and cultural differences impacted screening results and implementation in multiple studies.
Conclusions:
- Language and cultural factors significantly affect the validity and reliability of developmental screening for Spanish-speaking families.
- Spanish-translated instruments may not be psychometrically sound, potentially leading to misidentification of developmental risks.
- Validating translated screening tools is critical to reduce bias and improve access to pediatric services for Hispanic families.
Background:
Racial and ethnic disparities in the identification of developmental and behavioral concerns in children are public health problems in the United States. Early identification of developmental delay using validated screening instruments provides a pathway to prevention and intervention in pediatric health care settings. However, the validity of Spanish-language screening instruments, used in clinical settings in the United States, has not been systematically examined.
Objective:
This study aims to review the literature of clinically administered developmental and behavioral instruments with Hispanic caregivers to investigate implementation variation due to language and cultural factors.
Methods:
A systematic literature review using PubMed and PsycINFO was conducted of articles published from January 1, 2006 to December 12, 2017. Abstract, full-text, and critical appraisal resulted in 11 studies that met criteria for inclusion.
Results:
Five different instruments were used to screen Hispanic or Spanish-speaking caregivers of children younger than 6 years. None of the instruments established validity and reliability apart from Spanish translation. Two studies identified differences in screening results with Spanish-speaking caregivers due to language and 6 described cultural differences that impacted screening implementation. Two studies reported differential item functioning in Spanish-translated instruments.
Conclusions:
Language and cultural considerations are critical to the administration of valid and reliable screening in pediatric health care settings. Available developmental and behavioral Spanish-language-screening instruments function differently because of both language and culture, suggesting the tools are not as psychometrically valid when administered to Spanish-speaking families. Validation of translated screening instruments is essential to eliminate the possibility of detection bias or misidentification of developmental risk, improving early access to clinical services for Hispanic and Spanish-speaking families.
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