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

Summary Background This study describes the development and reliability testing of an observational tool to measure mother–child interactions with toddlers aged 2 years 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 2 years 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