Reliability and validity of the responsive care tool for children 0-3 years old in a rural, South Asian setting

Research has shown the importance of responsive caregiving for fostering positive development early in life; however, tools measuring these interactions are often impractical for larger scale intervention trials and in settings with resource constraints. The present study provides reliability and validity evidence from Sindh, Pakistan for a tool developed to quantify responsive caregiving. Data were collected from 200 randomly selected households on responsive caregiving, sociodemographic characteristics, early learning, and early child development. The results indicated that the responsive care tool can be feasibly administered in less than 5 min in a low-resource setting. An exploratory factor analysis found that the tool's indicators reliably loaded onto two distinct factors, responsive interactions and caregiver-initiated interactions, accounting for 96.01% of the underlying variation in scores. A confirmatory factor analysis reflecting input from modification indices showed satisfactory fit statistics and adequate factor loadings (all above .70). Internal consistencies of the two factors were also high, with alphas of .93 and .83, respectively. Convergent validity of the responsive interactions factor was demonstrated by a strong and positive correlation with measures of psychosocial stimulation, early learning, maternal education, and household wealth. Predictive validity of the responsive interactions factor was demonstrated by a strong and positive association with child development. The caregiver-initiated interactions factor was significantly and negatively associated with psychosocial stimulation and child development. The resulting evidence provides programs with an open access, observational, reliable, and valid measure to quantify responsive caregiving at the program level in low-resource settings.