Cultural factors in the utilization of the Denver Developmental Screening Test in a Navajo population

The development and use of standardized tools is common in nursing and medical practice. One tool that is widely used to screen childhood growth and development in the Developmental Screening Test (DDST) developed by Frankenburg and Dodds in 1967 at the University of Colorado Medical Center. Frankenburg and Dodds attempted to standardize the DDST according to socio-cultural variables, however, subsequent studies identity questions about possible cultural, ethnic, or socioeconomic biases of the DDST. The purpose of this study is to investigate the relationship of culture to the administration and scoring of the DDST by a Primary Care Nurse Practitioner (PCNP) when the DDST is used to evaluate the development of Navajo children. The theoretical framework of this study is based upon the belief that interactions between the concepts of culture and Primary Nursing Care Systems (PNCS) may affect the Health Outcomes of a particular population. Navajo children are of particular interest in this study. A retrospective chart survey of DOST's administered between January 1 and June 30, 1979, at the Maternal-Child Health Project, Shiprock, New Mexico was conducted to obtain data related to the culture of the PCNP and the scoring of the DOST's. DOST's included in the study were non-randomly selected and stratified according to the culture of the PCNP who administered the DOST. Culture of the PNCP's was operationalized as Navajo and non-Navajo. Three categories of culture, one Navajo and two non-Navajo, were obtained. Study hypotheses that the Navajo PCNP would score fewer items as failures on the DOST and fewer DOST as Abnormal and Questionable than the non-Navajo PCNP were tested. Analysis of data did not support the first hypothesis but did conditionally support the second. Incompletely administered DDST items may have affected the study data and results. Additionally, differences in education and experience of the PCNP's variations in language used in the administration of the DDST, possible cultural bias of some DDST items, selective item administration and scoring of the test items, and the influences of the child's or administrator's culture may have effected the study data and results. Study results indicate the need for further studies that control the effects of the extraneous variables uncounted in this study. Implications for further investigation into the validity, stability, and reliability of the DDST in a cultural setting, and continual observation and awareness of the functioning and interactions of culture and nursing care systems are suggested. Implications for changes in nursing curriculums at the basic and graduate level, and changes that will increase the awareness and appreciation of cultural differences and the research skills of nurses are discussed. The study findings indicate that some relationship does exist between culture and the PNCS; however, the nature of the relationship is not completely clear.