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Table 2 Strengths and Weaknesses of implementing the CAT/CLAMS and ASQ child development tool in Limpopo, South Africaa

From: Comparing Two Early Child Development Assessment Tools in Rural Limpopo, South Africa

 CAT/CLAMSASQ
StrengthsWeaknessesStrengthsWeaknesses
Usability- Calculates developmental score
- Well suited for hospital or school environment
- Feasible for use in clinic work flow
- Described as costly, time consuming, and difficult to calculate
- Score calculation is moderately challenging
- Better suited for low-volume days
- Described as easy, practical, uncomplicated, and simple
- Uncomplicated administration
- Visual graph to show where a child falls in relation to “cut off” scores
- Identified as primary assessment tool
- Feasible for use in clinic work flow
- Requires assessor to be literate
- Score calculation is mildly challenging
Resource ManagementNone identified- High cost of toys
- Long administration time
- Low cost
- Utilization of CHW
- Minimal time commitment for nurses
- Cost of copying assessment surveys
- Insufficient numbers of CHW to complete home assessments
Cultural AdaptationsNone identified- Moderate amount of translating needed
- Expensive toys which are not all culturally appropriate
None identified- Substantial amount of translating needed
- Poor access to copiers and printers
- Requires cultural modification of survey assessment questions
Patient and Parent Factors- Direct observation of child’s abilities
- Can use toys to teach mothers about meaningful play
- Spend more time with patients
- Nurses want to assess their own children using the tool
- Parents may not understand the importance of “play” during assessment and become impatient and leave
- Child may be afraid of the nurse and underperform
- Assessment done in-home
- Nurse can teach parents about results when they score the assessment tool
- Nurses distrust accuracy of information reported by parents
  1. aThe categories “current practice” and “new knowledge” are purposely omitted because there was no comparative data in either of these categories.