Abstract:
Background: The importance of child developmental screening is gaining increased traction
within low-resourced settings, but little is known about the implementation of screening
programs within clinical systems. This study aimed to evaluate the acceptability, feasibility,
fidelity, and sustainability of integrating a child developmental screening tool in a maternal and
child health (MCH) clinic in western Kenya.
Methods: This implementation study takes place within infrastructure of Academic Model
Providing Access to Healthcare (AMPATH). Developmental screening was integrated into MCH
care in September 2021 and is ongoing for children ages 18-36 months with perinatal HIV
exposure. Feasibility, sustainability, and fidelity are measured with weekly time-motion analysis
of clinic flow and daily clinic record review. Acceptability, feasibility, and sustainability were
evaluated using semi-structured interviews of caregivers and clinic staff, completed at baseline
and 6 months post-implementation. Mixed methods data were analyzed using descriptive
statistics, thematic coding, and triangulation.
Results: Since onset, 187 children were screened (69.8% of eligible children), with rate of
screening consistent over time. Average time to complete screening is 5.4 minutes and
decreasing over time. Perceived time of screening was inflated at baseline (≈16min) and 6
months (≈20min). Facilitators to screening included staff teamwork and caregiver cooperation.
Lack of time and child’s mood were barriers. Caregivers appreciated others’ concern for their
child’s development and noted ease in answering questions. Staff’s remarks were congruent,
while emphasizing the need for motivating incentives for children and staff. At 6 months, staff
noted screening had become routine. They desired feedback on performance and provided
ideas for improvement. Caregivers frequently asked about availability of assistance if potential
delays are identified during screening.
Conclusion: The integration of developmental screening is aided by positive perceptions from
both clinic staff and caregivers. Regular retraining, staff feedback, and referral resources may
optimize integration. Research evaluating cost effectiveness is needed.