Feasibility and acceptability of implementing the Global Scales for Early Development (GSED) package for children 0-3 years across three countries

Ambreen Nizar Merchant¹, Raghbir Kaur², Gareth McCray³, Vanessa Cavallera², Ann Weber⁴, Melissa Gladstone⁵, Magdalena Janus⁶, Imran Nisar⁷, Patricia Kariger⁸, Sunil Sazawal⁹, Arup Dutta⁹, Salahuddin Ahmed¹⁰, Yunting Zhang¹¹, Mariana Pacifico Mercadante¹², Arsene Zongo¹³, Yvonne Schönbeck¹⁴, Tarun Dua², Iris Eekhout¹⁴, Fahmida Tofail¹⁵, Maureen Black^{16

17}, Abdullah H Baqui¹⁸, Dana McCoy¹⁹, Farzana Begum⁷, Romuald Kouadio E Anago¹³, Alexandra Brentani¹², Fan Jiang¹¹, Symone Detmar¹⁴, Michelle Perez Maillard², Marcus Waldman²⁰, Stef van Buuren^{14

21}, Abbie Raikes²⁰, Katelyn Hepworth²⁰, Marta Rubio Codina²², Shirina Akhtar¹⁰, Fyezah Jehan⁷, Rasheda Khanam⁶, Hassan Naqvi⁷, Abrarul Haque Asif¹⁰, Junaid Mehmood⁷, Sidra Afzal⁷, Gillian Lancaster³

Affiliations

¹ Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan. ambreen.nizar@aku.edu.
² Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland.
³ School of Medicine, Keele University, Keele, UK.
⁴ School of Public Health, University of Nevada Reno, Reno, NV, USA.
⁵ Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
⁶ Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
⁷ Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan.
⁸ Center for Effective Global Action, University of California Berkeley School of Public Health, Berkeley, CA, USA.
⁹ Center for Public Health Kinetics, CPHK Global, Pemba, Zanzibar, Tanzania.
¹⁰ Research, Projahnmo Research Foundation, Dhaka, Bangladesh.
¹¹ Child Health Advocacy Institute, National Children's Medical Center, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
¹² Department of Pediatrics, University of São Paulo Medical School, São Paulo, Brazil.
¹³ Innovations for Poverty Action, IPA Côte d'Ivoire, Abidjan, Côte d'Ivoire.
¹⁴ Department of Child Health, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands.
¹⁵ Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.
¹⁶ International Education, RTI International, Research Triangle Park, NC, USA.
¹⁷ Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
¹⁸ International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
¹⁹ Education Policy and Program Evaluation, Harvard Graduate School of Education, Cambridge, MA, USA.
²⁰ Health Promotion, University of Nebraska Medical Center College of Public Health, Omaha, NE, USA.
²¹ Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, University of Utrecht, Utrecht, Netherlands.
²² Social Protection and Health Division, Inter-American Development Bank, Washington, DC, USA.

PMID: 39953573
PMCID: PMC11827458
DOI: 10.1186/s40814-024-01583-4

Feasibility and acceptability of implementing the Global Scales for Early Development (GSED) package for children 0-3 years across three countries

Ambreen Nizar Merchant et al. Pilot Feasibility Stud. 2025.

. 2025 Feb 14;11(1):18.

doi: 10.1186/s40814-024-01583-4.

Authors

Affiliations

¹ Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan. ambreen.nizar@aku.edu.
² Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland.
³ School of Medicine, Keele University, Keele, UK.
⁴ School of Public Health, University of Nevada Reno, Reno, NV, USA.
⁵ Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
⁶ Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
⁷ Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan.
⁸ Center for Effective Global Action, University of California Berkeley School of Public Health, Berkeley, CA, USA.
⁹ Center for Public Health Kinetics, CPHK Global, Pemba, Zanzibar, Tanzania.
¹⁰ Research, Projahnmo Research Foundation, Dhaka, Bangladesh.
¹¹ Child Health Advocacy Institute, National Children's Medical Center, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
¹² Department of Pediatrics, University of São Paulo Medical School, São Paulo, Brazil.
¹³ Innovations for Poverty Action, IPA Côte d'Ivoire, Abidjan, Côte d'Ivoire.
¹⁴ Department of Child Health, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands.
¹⁵ Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.
¹⁶ International Education, RTI International, Research Triangle Park, NC, USA.
¹⁷ Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
¹⁸ International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
¹⁹ Education Policy and Program Evaluation, Harvard Graduate School of Education, Cambridge, MA, USA.
²⁰ Health Promotion, University of Nebraska Medical Center College of Public Health, Omaha, NE, USA.
²¹ Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, University of Utrecht, Utrecht, Netherlands.
²² Social Protection and Health Division, Inter-American Development Bank, Washington, DC, USA.

PMID: 39953573
PMCID: PMC11827458
DOI: 10.1186/s40814-024-01583-4

Erratum in

Correction: Feasibility and acceptability of implementing the Global Scales for Early Development (GSED) package for children 0-3 years across three countries.
Merchant AN, Kaur R, McCray G, Cavallera V, Weber A, Gladstone M, Janus M, Nisar I, Kariger P, Sazawal S, Dutta A, Ahmed S, Zhang Y, Mercadante MP, Zongo A, Schönbeck Y, Dua T, Eekhout I, Tofail F, Black M, Baqui AH, McCoy D, Begum F, Anago RKE, Brentani A, Jiang F, Detmar S, Maillard MP, Waldman M, van Buuren S, Raikes A, Hepworth K, Codina MR, Akhtar S, Jehan F, Khanam R, Naqvi H, Asif AH, Mehmood J, Afzal S, Lancaster G. Merchant AN, et al. Pilot Feasibility Stud. 2025 Mar 28;11(1):34. doi: 10.1186/s40814-025-01620-w. Pilot Feasibility Stud. 2025. PMID: 40155994 Free PMC article. No abstract available.

Abstract

Background: To assess the neurodevelopment of children under three years, a multinational team of subject matter experts (SMEs) led by the World Health Organization (WHO) developed the Global Scales for Early Development (GSED). The measures include (1) a caregiver-reported short form (SF), (2) a directly administered long form (LF), and (3) a caregiver-reported psychosocial form (PF). The feasibility objectives of this study in Bangladesh, Pakistan, and the United Republic of Tanzania were to assess (1) the study implementation processes, including translation, training, reliability testing, and scheduling of visits and (2) the comprehensibility, cultural relevance, and acceptability of the GSED measures and the related GSED tablet-based application (app) for data collection for caregivers, children, and assessors.

Methods: In preparation for a large-scale validation study, we implemented several procedures to ensure that study processes were feasible during the main data collection and that the GSED was culturally appropriate, including translation and back translation of the GSED measures and country-specific training packages on study measures and procedures. Data were collected from at least 32 child-caregiver dyads, stratified by age and sex, in each country. Two methods of collecting inter-rater reliability data were tested: live in-person versus video-based assessment. Each country planned two participant visits: the first to gain consent, assess eligibility, and begin administration of the caregiver-reported GSED SF, PF, and other study measures and the second to administer the GSED LF directly to the child. Feedback on the implementation processes was evaluated by in-country assessors through focus group discussions (FGDs). Feedback on the comprehensibility, relevance, and acceptability of the GSED measures from caregivers was obtained through exit interviews in addition to the FGD of assessors. Additional cognitive interviews were conducted during administration to ensure comprehension and cultural relevance for several GSED PF items.

Results: The translation-back translation process identified items with words and phrases that were either mistranslated or did not have a literal matching translation in the local languages, requiring rewording or rephrasing. Implementation challenges reiterated the need to develop a more comprehensive training module covering GSED administration and other topics, including the consent process, rapport building, techniques for maintaining privacy and preventing distraction, and using didactic and interactive learning modes. Additionally, it suggested some modifications in the order of administration of measures. Assessor/supervisor concurrent scoring of assessments proved to be the most cost-effective and straightforward method for evaluating inter-rater reliability. Administration of measures using the app was considered culturally acceptable and easy to understand by most caregivers and assessors. Some mothers felt anxious about a few GSED LF items assessing motor skills. Additionally, some objects from the GSED LF kit (a set of props to test specific skills and behaviors) were unfamiliar to the children, and hence, it took extra time for them to familiarize themselves with the materials and understand the task.

Conclusion: This study generated invaluable information regarding the implementation of the GSED, including where improvements should be made and where the administered measures' comprehensibility, relevance, and acceptability needed revisions. These results have implications both for the main GSED validation study and the broader assessment of children's development in global settings, providing insights into the opportunities and challenges of assessing young children in diverse cultural settings.

Keywords: Early childhood development; Feasibility; Global; Measurement; Monitoring; Scales.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study complies with the International Ethical Guidelines for Biomedical Research Involving Human Subjects [45] and received ethical approval from the WHO Ethics Board (Ref 004583), followed by ethical approval from institutional ERCs of individual study sites. From Pakistan, approval was sought from the National Bioethics Committee NBC (Ref 4–87/NBC-/422/19/1170) and Aga Khan University AKU (Ref. 1567). For the Bangladesh site, approval was obtained from the Institutional Review Board (IRB) of the Projahnmo Research Foundation (PR-190002) and Johns Hopkins Bloomberg School of Public Health (IRB No.: 00009615). In the United Republic of Tanzania-Pemba, the study was approved by the Zanzibar Health Research Ethics Committee (Ref: ZAHREC/03/PR/Sept/2019/02). Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

**Fig. 1**
a Home page of the GSED app on a tablet. b GSED long form grid

See this image and copyright information in PMC

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Feasibility and acceptability of implementing the Global Scales for Early Development (GSED) package for children 0-3 years across three countries

Affiliations

Feasibility and acceptability of implementing the Global Scales for Early Development (GSED) package for children 0-3 years across three countries

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources