The development and reliability of an observational tool for assessing mother-child interactions in field studies- experience from Pakistan

Document Type



Paediatrics and Child Health


This study describes the development and reliability testing of an observational tool to measure mother-child interactions with toddlers aged 2years in a rural low-income country setting.Methods: The development protocol comprised five phases with iterative revisions: (1) identification of the theoretical framework for responsive behaviours and selection of items; (2) field testing; (3) expert review; (4) training of the data collection team; and (5) piloting. The final tool was a structured live observational measure assessing a 5-min interaction of a shared picture-book-reading activity. Maternal behaviours assessed included affect, touch, verbal statements and language stimulation; child behaviours assessed included affect, communication and attention.Results: Following development, the mother-child interaction tool was administered on a cohort of 1390 children at 2years of age. Using a video strategy, inter-observer reliability assessed by the Bland-Altman test for mother-child dyads suggested moderate agreement between expert and field assessors on total scores (r=0.681**, P<0.001, n=154). Significant associations of the total interaction score correlations using Pearson's' correlations were found with the Responsiveness (r=0.271**, P<0.001, n=1345) and Involvement (r=0.325**, P<0.001, n=1345) subscales of the Home Observation for Measurement of Environment-Infant Toddler Inventory, maternal knowledge (r=0.203**, P<0.001, n=1345), maternal depression (r=.-063**, P<0.001, n=1345), child cognitive development (r=0.392**, P<0.001, n=1345) and language development (r=0.620**, P<0.001, n=1345) assessed using the Bayley Scales for Infant and Toddler Development, Third Edition.CONCLUSION: The authors conclude that this tool can be reliably used by trained assessors to measure mother-child interactions in field studies.