Experiencia de la aplicación y criterios para la interpretación de dos versiones del Inventario HOME para infantes de 0 a 3 años de vida / Application experience and criteria for the interpretation of two versions of Infant-Toddler HOME

ABSTRACT

The Home Observation for the Measurement of the Environment (HOME) Inventory is the most widely used tool in evaluating the environmental stimulation and family potential to provide necessary cognitive, social, and emotional support available to the child development. The HOME uses an observation/interview format to measure specific interactions between the caregiver and the child, various issues and events that might stimulate the child, and a variety of experiences provided at home or by family members that offer opportunity for growth and development. There are several versions to use from birth to age 3 (Infant-Toddler HOME), the most famous data come the late 60's (1968), it is composed by 45 items (HOME-45) clustered into six subscales. It has a back up of 40 years of publications, over 650 papers, associating with the children's language development, intellectual performance, and academic achievement or psychosocial and socioeconomic characteristics of the family. In Mexico, there are only two published version reports of the use of HOME-45. Most reports refer to the version of Cravioto from the late 60's, with 7 subscales and 62 items (HOME-62) from which there's poor information in the literature about the criteria for to interpreter the outcome results. The aim is to show the results of the implementation of both versions of HOME inventory, and provide criteria for interpretation in a sector of the Mexican population of low socioeconomic status. Material and methods We studied 1031 children and their homes from three communities of low socioeconomic status of central Mexico. Explaining the procedures and obtained informed consent, they were visited at home to implement the HOME Inventory and the socio-economic survey, with a 95% interobserver reliability. The procedures performed were approved by the Ethics and Research Committees from National Pediatric Institute. We applied the HOME-45 and HOME-62 in a integrated format to obtain the total score and each subscale from each version. It was also felt cut-off formed three groups with low stimulation (lowest fourth), middle stimulation (middle half) and high stimulation (upper fourth). The HOME-45 applies all the items to children 0 to 3 years; in the HOME-62 before 3 months old are evaluated only 50 items and after 3; 9; 12; 15 and 18 months old apply 54; 55; 57; 59 and 62 items respectively. Depending on the age, 26 to 36 items are common, representing from 58 to 80% of HOME-45 and 52 to 58% of HOME-62. There is no correspondence between the subscales of both versions, they have a different name and composition of items; so, we consider both versions as different. Social survey A modified version of the socio-economic interview of the National Pediatric Institute was applied, therefore three levels were established medium low, low and very low social-economic status. Statistical analysis Four groups were formed by age range of children, to analyze the version HOME-45 and 6 groups for HOME-62 version, depending on the number of applicable items indicated in the format. The analysis related to HOME-62 considered only those items that the format indicates to apply for specific ages. Analyze was performed using JMP statistical software (version 5.01; SAS). We used ANOVA, Student's t test or Tukey Kramer's test to examine differences between means and chi square test to assess differences between proportions; p< 0.05 was considered statistical significance. Results 52.7% of the children were female, aged 1 to 35 months ( = 16.2 ± 9.3 months) mother was the primary caregiver of the child at 87.8%. The mean mother's age was 26.5 ± 5.7 years with a range of 14 to 43 years, the father's age was 29.8 ± 7.34 years. Mother's education mean was 9 years, 24% elementary school or less. HOME-45 Inventory achieved mean score in the population of 31.02 ± 5.68 points, equivalent to a hits proportion of 0.69 ± 0.13, with limits between 0.51 (variety) to 0.81 (responsibity). We found statistical significance differences in the total score of HOME-45 Inventory according to socioeconomic and marital status, birth order of children, education and age of parents. There were also found differences between all subscales of HOME-45 with the socioeconomic status and parent's education. With scores of HOME-45 Total difference was found between children younger than 6 months respect to older. There were also differences in the same sense in the subscales except for Acceptance and Organization subscales. It was considered the cutoff point for low, medium and high stimulation in the total population (0-35 months), to total scale and each subscale, the most important differences observed occurred in children under 6 months of age. HOME-62 Inventory (Cravioto) The total score and the subscales of HOME-62 also showed associations with sociodemographic variables such as education, age and marital status from parents, socioeconomic family status and birth order of children. Scores reached at the HOME-62 were equivalent to the hits proportion of 0.74 ± 0.1 , all subscales showed mean higher than 0.5 and three above 0.8. There were major differences in the total score of HOME-62 considering the age group proposed, similar differences were observed in most of the subscales. The cut-off points for types of stimulation of total HOME-62 tend to increase with the age of the child. The same happened with the subscales except Frequency and Stability of adult contact and Emotional climate, were descended. It was compared the relationship between the two versions of HOME once the criteria proposed was applied 719 family environments were similarly characterized by both versions (69.7%) and 235 environments (22.8%) were defined by the HOME-45 with great stimulation while 80 environments (7.8%) were defined by the HOME-62 with great stimulation too. Discussion There are no benchmarks in the Mexican population for any of the two versions of HOME used. And the international benchmarks HOME-45 were obtained from American families for over 30 years, being important to have results related to its application and interpretation of HOME-45 in a sector of the Mexican population, allowing contrasting findings regarding those obtained in other latitudes. HOME-62 version is the most widely used in Mexico, but little has been reported about the achieved scores, because there are no criteria for interpretation. The values proposed in this paper can be used in future comparisons with the results of other studies. Differences in scores of each version of HOME according to the age of the children, make it necessary to show the results adjusted by age ranges, common procedure in several instruments. The results of HOME-45 in the population were similar to those obtained in other data, there were no statistical differences with the Little Rock values in the total score, and it existed with the subscales of Acceptance and Organization. Like in that population, the tendency to increase the total score of HOME-45 with age was due mainly to Learning materials and Variety subscales. The results of HOME-62 provide benchmarks for its interpretation in 6 age group and all subscales. If they are applied to the results of the Cravioto's investigation, they are able to differentiate families with a history of malnourished children in the early years of life. Both versions showed ability to discriminate socio-economic characteristics of family. It is necessary to report results of the implementation of HOME in different contexts in qualitative and quantitative terms for a proper comparison and interpretation of the differences between groups as well as analyzing the relationship between the specific results in the subscales of both versions with the development, behavior and welfare of children.

RESUMEN

El instrumento más utilizado en la evaluación del potencial del ambiente familiar para brindar estimulación y apoyo necesario al desarrollo del niño, es el Inventario HOME (Home Observation for the Measurement of the Environment). La versión más conocida internacionalmente, para niños de cero a tres años, contiene 45 reactivos (HOME-45). En México la mayoría de reportes se refiere a una versión modificada por Cravioto con 62 reactivos (HOME-62), con poca información sobre los criterios para su interpretación. No existe correspondencia en el nombre de las subescalas de ambas versiones ni en los reactivos que las conforman, por lo que se consideran ambas versiones como distintas. No existen valores de referencia para la población mexicana de ninguna de las dos versiones utilizadas del HOME. Objetivo Mostrar los resultados de la aplicación de ambas versiones del inventario HOME y ofrecer criterios para su interpretación en un sector de la población mexicana de condición socioeconómica baja. Material y métodos Se estudiaron 1031 niños y sus hogares mediante visitas domiciliarias en tres comunidades del estrato socioeconómico bajo del centro de México. Los procedimientos tuvieron una confiabilidad interobservador del 95% y fueron aprobados por los Comités de Investigación y Ética del Instituto Nacional de Pediatría. Se obtuvo la puntuación para cada una de las versiones y se estimaron puntos de corte formándose tres grupos de estimulación, según la distribución cuartilar. Resultados El cincuenta y dos punto siete por ciento de los niños fue del sexo femenino, revistas/sm/v33n1/a7s1.jpg" > o = 16.2 ± 9.3 meses de edad, el cuidador principal del niño fue la madre en el 87.8%. La puntuación alcanzada por la población en el Inventario HOME-45 fue de 31.02 ± 5.68 puntos. Se encontraron diferencias significativas en la puntuación del HOME-45 y las subescalas según el orden de nacimiento del niño, la condición socioeconómica, el estado conyugal, la edad y escolaridad de los padres. Se estimó el punto de corte para la baja, media y alta estimulación observándose las diferencias más importantes en los menores de seis meses de edad. Inventario HOME-62 La puntuación total y la de las subescalas del HOME-62 también mostraron asociación con las variables sociodemográficas; la puntuación total del HOME-62 fue equivalente a una proporción de aciertos de 0.74±0.1. Se observaron diferencias en la puntuación total y en la mayoría de las subescalas del HOME-62 según los intervalos de edad propuestos. Los puntos de corte para los tipos de estimulación del HOME-62 tienden a incrementarse con la edad del niño e igual sucede con la mayoría de las subescalas. La relación entre ambas versiones del HOME, una vez aplicados los criterios propuesto, mostró 69.7% de ambientes familiares tipificados de igual manera por ambas versiones, 22.8% tipificados con mayor estimulación por el HOME-45 y 7.8% de ambientes tipificados con mayor estimulación por el HOME-62. Conclusiones Es importante contar con referentes para la interpretación del HOME-45 en habitantes de México, que permita contrastar los hallazgos respecto a los obtenidos en otras latitudes. El HOME-62 es la versión más utilizada en México, pero se han reportado poco las puntuaciones alcanzadas, en parte porque no hay criterios para su interpretación. Se presentaron los resultados ajustados a intervalos de edad, procedimiento común en diversos instrumentos. Los valores propuestos en el presente trabajo pueden usarse en futuras comparaciones con los resultados de otros estudios. Los resultados del HOME-62 aportan referentes para su interpretación en seis intervalos de edad en cada subescala. Ambas versiones muestran capacidad para discriminar características socioeconómicas de las familias. Es necesario reportar resultados de la aplicación del HOME en diversos contextos en términos cualitativos y cuantitativos para una adecuada comparación e interpretación de las diferencias entre grupos, así como analizar las relaciones entre los resultados específicos en las subescalas de ambas versiones con el desarrollo, comportamiento y bienestar del niño.