Reliability and validity of the Caregiver Reported Early Development Instruments (CREDI) in impoverished regions of China

Abstract

Background There is a great need in low- and middle- income countries for sound qualitative and monitoring tools assessing early childhood development outcomes. Although there are many instruments to measure the developmental status of infants and toddlers, their use in large scale studies is still limited because of high costs in both time and money. The Caregiver Reported Early Development Instruments (CREDI), however, were designed to serve as a population-level measure of early childhood development for children from birth to age three, and have been used in 17 low- and middle-income countries. This study aimed to examine the reliability and validity of the CREDI in China, which is still unknown. Methods The CREDI and the ASQ-3 was administered to a sample of 946 children aged 5–36 months from urban and rural communities, in which 248 children was administered with Bayley-III. Results The internal consistency of the CREDI was high, which indicates that the scale internal consistency reliability is quite good. The results also indicated that the concurrent validity of the CREDI with the Bayley-III scale was high in general. Ordinary least squares regression showed that the CREDI is highly consistent with previous widely used instruments in some key predictors (such as the home stimulation) of early childhood development level. Conclusions All the results in the current study indicate that the CREDI may be considered an appropriate instrument to measure early childhood development status on a large scale in impoverished regions of China.

Measuring early childhood development: considerations and evidence regarding the Caregiver Reported Early Development Instruments

“…To date, several studies have examined the psychometric properties of the CREDI, showing evidence for its reliability, validity, and comparability in a number of different areas. This evidence largely stems from work conducted by the original developers of the CREDI using data from more than 8000 children in 17 low-, middle-, and high-income countries but has increasingly been complemented by more localized validation efforts, including work in Brazil, 15 China, 16 and India (this issue). With regard to validity, multidimensional item factor analyses applied to the original multicountry validation sample revealed evidence of construct validity of the CREDI's long form.…”

“…There is also evidence to support the CREDI's discriminant validity, including expected variation in CREDI scores based on children's age, 10,11,[15][16][17] sex, 10,[16][17][18] anthropometric status, 10,11,17 disability status, 17 household socioeconomic status, 10,15,16 caregiver education level, 10,15,17 receipt of stimulation at home, 10,11,[15][16][17][18] and experiences of physical punishment 18 across a wide variety of contexts. Finally, several studies have shown evidence for the criterion validity of the CREDI in comparison to other widely used measures of ECD.…”

“…Finally, several studies have shown evidence for the criterion validity of the CREDI in comparison to other widely used measures of ECD. Although this work has typically focused on smaller numbers of children in select contexts, it has demonstrated positive associations between the CREDI and different direct assessment and caregiver-reported tools, including the BSID (China, Pakistan, and Tanzania), 10,11,16,17 the Ages and Stages Questionnaire (Chile and China), 10,11,16 the MacArthur Bates Communicative Development Inventory (Chile), 10,11 the INTERGROWTH Neurodevelopmental Assessment (Zambia), 10,11 and the Inter-American Development Bank's Regional Project on Child Development Indicators (Brazil). 10,11,15 Evidence on the CREDI's reliability largely falls into two areas.…”

“…First, studies have shown robust evidence for the internal consistency of the CREDI's short-and long-form scores, with Cronbach's alpha values typically hovering around 0.80. 10,11,[15][16][17] Second, evidence from a subset of participants and settings has shown evidence for the CREDI's testretest reliability over an approximately 7-to 10-day period. 10,11 Indeed, sufficient stability in participant responses was considered a criterion for individual items' inclusion in the final version of the CREDI.…”

“…Nevertheless, there are a number of considerations relevant with regard to the caregiver report format that have not yet been explicitly studied. For example, although evidence from China showed no discernable differences between mothers' and grandmothers' reports on the CREDI, 16 the influence of the reporter on CREDI scores has not been widely studied. Furthermore, although prior work has shown that the CREDI provides relatively similar results when administered using either an interview or written/online format, 15,28 its performance via phone has not yet been assessed.…”