Transitioning to a Flexible, Tiered, Developmentally Informed Same‐Day Screening Model for Preschoolers in Low‐Resource Settings.
Background: The preschool years (ages 3–5) represent a critical window for promoting development and lifelong health. However, in many low‐resource settings, developmental delays, sensory impairments and emerging health risks often go undetected. Although early, integrated screening improves outcome...
| Published in: | Child: Care, Health & Development Vol. 52; no. 2; pp. 1 - 24 |
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| Main Authors: | , , , , , , , , , , , , |
| Format: | pictorial research tables/charts Journal Article |
| Published: |
Wiley-Blackwell
Mar2026
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=192463244&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 192463244 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03051862 6NX jtl: Child: Care, Health & Development issn: 03051862 maglogo: Y pubinfo: dt: Mar2026 vid: 52 iid: 2 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 192463244 192463244 192463244 10.1111/cch.70242 192463244 ppf: 1 ppct: 23 formats: tig: atl: Transitioning to a Flexible, Tiered, Developmentally Informed Same‐Day Screening Model for Preschoolers in Low‐Resource Settings. aug: au: Smith, Robyn Jordaan, Elizabeth M. Russell, Dorothy C. de Milander, Monique van Rooyen, Marlie Jansen van Vuuren, Xany Devenier, Minette Bonafede, Carmen Louw, Marshe Kruger, Annelize Sivhugwana, Innocentia Nkomo, Thembi van der Merwe, Minzke affil: School of Health and Rehabilitation Sciences, University of the Free State, Bloemfontein, South Africa sug: subj: Developmental Disabilities Diagnosis Health Screening Methods Early Childhood Intervention Health Services Accessibility Resource-Limited Settings Low and Middle Income Countries Human Male Female Adolescence Adult Middle Age Aged Parents of Children with Disabilities Child, Preschool Children with Disabilities South Africa Descriptive Research Nonexperimental Studies Comparative Studies Descriptive Statistics Questionnaires Conceptual Framework Hearing Screening Vision Screening Anthropometry Sphygmomanometers Center for Epidemiological Studies Depression Scale Physical Activity Patient Navigation Waiting Lists Child Development Child Health Services Medically Underserved Area Funding Source Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Child, Preschool: 2-5 years Male Female ab: Background: The preschool years (ages 3–5) represent a critical window for promoting development and lifelong health. However, in many low‐resource settings, developmental delays, sensory impairments and emerging health risks often go undetected. Although early, integrated screening improves outcomes, early childhood care and education (ECCE) platforms in low‐ and middle‐income countries (LMICs) are underutilized for delivering preventive services. Implementation is hindered by limited resources, poor intersectoral coordination, logistical constraints and low caregiver engagement. This study describes the iterative refinement of an initial screening protocol into a proposed flexible, tiered screening model, embedded within a guiding framework tailored to ECCE settings in LMICs. Methods: An observational, descriptive study was conducted in low‐resource urban, peri‐urban and rural communities in a central South African province to collect baseline data on preschoolers' development, sensory functioning (vision and hearing), nutrition and health (including blood pressure). The initial multi‐indicator protocol was implemented and refined using a Participatory Action Learning and Action Research (PALAR) approach. Feedback from caregivers, ECCE facilitators, interpreters, student fieldworkers and healthcare professionals guided adaptations. Results: Stakeholders identified key barriers, including fragmented caregiver–child scheduling, long assessment sessions, limited interpreter resources, caregiver disengagement and difficulty engaging children with developmental and behavioural challenges. In response, a proposed model was developed to consolidate visits, reduce session duration, enhance interpreter support and streamline screening tools. The flexible, tiered structure of this proposed model allows assessors to tailor screening based on observed functional capacity, improving feasibility, accuracy and cultural responsiveness. It supports scalable application across similar low‐resource ECCE contexts. Conclusions: This developmentally informed, proposed screening model, operating within a flexible framework, offers a context‐sensitive, scalable approach to improving early identification and referral in LMIC ECCE settings. Its adaptable structure supports broader implementation, enhances alignment with children's developmental needs and informs future policy and integrated service planning. Summary: Screening design informed by developmental readiness and cultural–linguistic fit enhances feasibility and accuracy in diverse settings.A flexible, tiered model supports early identification by aligning assessments with developmental ability, reducing unnecessary referrals.A same‐day, integrated format improves participation and offers a practical model for ECCE service delivery.A focused screening scope balances value and manageability, supporting implementation in low‐resource contexts.Scalable delivery by trained lay personnel, with interpreter support, offers an inclusive workforce model for broader uptake. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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