Rivera GR, Figueroa OM, Soler LKM, Sánchez C, Ávila RH

Language: Spanish
References: 23
Page: 57-66
PDF size: 149.11 Kb.

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 (0=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.

REFERENCES

1. Caldwell BM, Bradley RH. Home observation for measurement of the environment. Little Rock, Arkansas: University of Arkasas; 1984.

2. Kolobe THA. Childrearing practices and developmental expectations for Mexican-American mothers and the developmental status of their infants. Physical Therapy 2004;84(5):439-456.

3. Bradley RH, Mundfrom DJ, Whiteside L, Casey PH, Barrett K. A factor analytic study of the infant-toddler and early childhood versions of the HOME Inventory administered to white, black, and Hispanic American parents of children born preterm. Child Dev 1994;65(3):880-888.

4. Bradley RH. Children’s home environments, health, behavior, and intervention efforts: a review using the HOME inventory as a marker measure. Genetic, Social General Psychology Monographs 1993;119(4):437-90.

5. Bradley RH, Corwyn RF. Caring for children around the world: A view from HOME. International J Behavioral Development 2005;29(6):468-478.

6. Peña Ramos MO, Aguilar Rodríguez C, Vera Noriega JA. Pareja, estimulación y desarrollo del infante en zona rural en pobreza extrema. Revista Mexicana Investigación Educativa 2005;10(25):559-576.

7. Soler-Limón KM, Rivera-González IR, Figueroa-Olea M, Sánchez-Pérez MC, Sánchez-Pérez L. Relación entre las características del ambiente psicosocial en el hogar y el desarrollo psicomotriz en el niño menor a 36 meses de edad. Bol Med Hosp Infant (Méx) 2007;64:273-287.

8. Vera Noriega JA. Análisis del microambiente familiar y el estado nutricio de infantes y preescolares en comunidades rurales sin pobreza extrema del norte de México. Bol Clín Hosp Infant (Son) 1996;13(1):2-8.

9. Cravioto J, Arrieta R. Nutrición, desarrollo mental, conducta y aprendizaje. Segunda edición. México: Sistema Nacional para el Desarrollo Integral de la Familia, Instituto Nacional de Ciencias y Tecnologías; 1985.

10. Cravioto J, Matsubara M, López M, Arrieta R. Evaluación del desarrollo cognoscitivo de lactantes y preescolares con escalas simplificadas. En: Zubirán S, Arroyo P, Ávila H (eds). La nutrición y la salud de las madres y los niños mexicanos. México: Pediatría. Secretaria de Salud. Fondo de Cultura Económica; 1990.

11. Caldwell B. Descriptive evaluations of child development and of developmental settings. Pediatrics 1967;40:46-50.

12. Zanabria M, Márquez ME, Pérez A, Méndez I. Consistencia interna a lo largo de un año del Inventario HOME-Infantes en un grupo de niños de la Ciudad de México y zona metropolitana. Salud Mental 2007;30(2):67-73.

13. Ontiveros E, Cravioto J, Sánchez MC, Barragan G. Evaluación del desarrollo motor en función de género, estimulación disponible en el hogar y nivel socioeconómico en niños de 0 a 3 años de edad en el área rural. Bol Med Hosp Inf 2000;57(6): 311-19.

14. Bradley RH, Mundfrom DJ, Whiteside L, Caldwell BM, Casey PH et al. A reexamination of the association between HOME scores and income. Nurs Res 1994;43(5):260-266.

15. Lozoff B, Park AM, Radan AE, Wolf AW. Using the HOME Inventory with Infants in Costa Rica. International J Behavioral Development 1995;18(2):277-295.

16. Aguilar M, Fernández X, Luna G, Ocampo R, Torres A et al. Cédula socioeconómica comparada con estudio social. Análisis en el Instituto Nacional de Pediatría. Acta Pediatr Méx 2001;22(2):118-121.

17. AMAI. Avances del Comité de Niveles Socioeconómicos. En: Comité de Niveles Socioeconómicos. México: Asociación Mexicana de Agencias de Investigación de Mercados y Opinión Pública, A.C.; 2004.

18. Caldwell BM, Bradley RH. HOME inventory administration manual. Arkansas: Little Rock; Edit. Print Design Inc; 2003.

19. Sumner G, Spietz A. NCAST caregiver/parent-child interactions feeding manual. Seattle: NCAST Publications, University of Washington; School of Nursing; 1994.

20. Muñoz Ledo P, Soto F, Figueroa M, Martínez RI, González A, et al. Desarrollo y estimulación en el hogar en un grupo de niños con pérdida auditiva. Revista Ciencias Clínicas 2006;7(2):73-80.

21. Ferré Calacich IM, Izazola Ezquerro SC, Martínez Wbaldo MC, Reyes García CE. Grado de estimulación en el hogar medido con el Inventario HOME en una muestra de niños con hipoacusia bilateral profunda. Datos preliminares. An Orl Mex 2006;51(3):101-104.

22. Torralva TC, Manso M, Sauton F, Ferrero M, ODonnell A et al. Desarrollo mental y motor en los primeros años de vida: su relación con la estimulación ambiental y el nivel socio económico. Arch Argent Pediatr 1999;97(5):306-316.

23. Cravioto J, DeLicardie E. Microenvironmental factors in severe proteincalorie malnutrition. En: Scrimshaw NS, Behar M, (eds). Nutrition and agricultural development. New York: Plenum Publishing Corporation; 1976.