Development And Evaluation Of The Caregiver’s Nurturing Care Practice Questionnaire Aged 0-3

[Objective]To meet the need of a standard tool with high validity and reliability for assessing the nurturing care practices of Chinese caregivers,we aimed to develop the Caregiver’s Nurturing Care Practice Questionnaire(C-NCPQ),and test its reliability and validity to provide methodological support for subsequent researchers and child health workers on relevant assessment techniques.[Methods]1.Develop the Caregiver’s Nurturing Care Practice Questionnaire:After wide literature search and review,16 experts in the fields of pediatrics,child health,and psychometrics were invited to discuss the culture and concepts of parenting in China,based on the Nurturing care Framework proposed by WHO and UNICEF and combined with the expert consensus,we preset the basic dimensions and items to formulate the initial version of C-NCPQ.After pilot testing,the questionnaire was modified the expression of items and names of dimensions that are easy to generate ambiguity and difficult for parents to understand.The revised questionnaire was pre-surveyed and combined the opinions of the expert workshops to form the official questionnaire.2.Formal questionnaire reliability and validity evaluation:Using the principle of convenience sampling,we selected 4 early childhood development centers of maternal and child health hospital in Beijing,Zhejiang Province and Shenzhen City,and organized 851 parents of infants and toddlers aged 0-3 years to fill in the electronic questionnaire.Internal consistent reliability,test-retest reliability,split-half reliability were used to assess the reliability of the questionnaire;the validity evaluation was based on the construct validity and criteria validity,and the Index of Child Care Environment(ICCE)and the Child Home Nurture Environment Scales were used as criteria.3.Level of nurturing care practices and socio-demographic influences analysis:the means and standard deviations were used to describe the current level of nurturing care practices of parents.Non-parametric test analysis was used to compare the differences in scores of each dimension of the questionnaire among different age groups of children,parents’education level,household income level and different regions to explore the socio-demographic factors that may influence the level of nurturing care practices of parents.[Results]1.The Caregiver’s Nurturing Care Practice Questionnaire was developed through literature review,pilot testing,pre-survey,and several expert workshops,resulting in an official version of the questionnaire with 60 items in 6 dimensions:nurturing methods,health care,nutrition and feeding,responsive caregiving,early learning opportunities,security and safety.and all items were scored on a 0-2 Likert scale,with options"never/occasionally","sometimes",and"often/always"were given a score of 0-2,and the total score of the questionnaire ranged from 0-120,with higher scores representing better nurturing care practices.The higher the score,the better the nurturing care practice.2.A formal questionnaire was administered to 851 parents of infants andtoddlers aged 0-3 in 4 maternal and child health hospitals in 3 cities,and the items were re-screened based on the returned data,resulting in 44 items in 6 dimensions.The questionnaire dimensions were nurturing methods,health care,nutrition and feeding,responsive caregiving,early learning opportunities,Security and safety,with3-10 items in each dimension.The Cronbach’αcoefficient of the questionnaire was0.913,and each dimension ranged from 0.453 to 0.852.The Guttman split-half reliability coefficient was 0.853,and the correlation coefficient of the test-retest reliability of the questionnaire was 0.745,and each dimension ranged from 0.496 to0.705.The validated factor analysis fit indices were:X~2/df=2.24,RMSEA=0.038,CFI=0.848,TLI=0.836,SRMR=0.50,and the model was considered acceptable,and the entry factor loadings were all>0.3,and the differences were statistically significant(all P<0.001).The validity correlation coefficient between the questionnaire and the ICCE was 0.561,and the dimensions ranged from 0.320 to 0.519;the validity correlation coefficient with the Questionnaire on Family Parenting Environment for 0-1 year olds was 0.406,and the validity correlation coefficient with the Questionnaire on Family Parenting Environment for 1-3 year olds(urban version)was 0.600.3.The scores of the Caregiver’s Nurturing Care Practice Questionnaire(C-NCPQ)aged 0-3 years in the three cities were 72.78±10.12.The preliminary analysis showed that there was no statistically significant difference in the scores of each dimension among parents of children of different genders,gestational age,and whether they were born prematurely,and the family economic level and parental education were related to the scores of the C-NCPQ.[Conclusion]The six dimensions of nurturing methods,health care,nutrition and feeding,responsive caregiving,early learning opportunities,security and safety were used to evaluate the level of nurturing care practices of infants and toddlers,and this questionnaire has been validated to have good reliability and validity,and is simple to administer.It can be used as a tool to assess the level of nurturing care practices of parents of infants and toddlers and to provide parents with evaluative guidance.