Table 2.

Strengths and Weaknesses of implementing the CAT/CLAMS and ASQ child development tool in Limpopo, South Africa^a

	CAT/CLAMS		ASQ
	Strengths	Weaknesses	Strengths	Weaknesses
Usability	- Calculates developmental score - Well suited for hospital or school environment - Feasible for use in clinic work flow	- Described as costly, time consuming, and difficult to calculate - Score calculation is moderately challenging - Better suited for low-volume days	- Described as easy, practical, uncomplicated, and simple - Uncomplicated administration - Visual graph to show where a child falls in relation to “cut off” scores - Identified as primary assessment tool - Feasible for use in clinic work flow	- Requires assessor to be literate - Score calculation is mildly challenging
Resource Management	None identified	- High cost of toys - Long administration time	- Low cost - Utilization of CHW - Minimal time commitment for nurses	- Cost of copying assessment surveys - Insufficient numbers of CHW to complete home assessments
Cultural Adaptations	None identified	- Moderate amount of translating needed - Expensive toys which are not all culturally appropriate	None identified	- Substantial amount of translating needed - Poor access to copiers and printers - Requires cultural modification of survey assessment questions
Patient and Parent Factors	- Direct observation of child’s abilities - Can use toys to teach mothers about meaningful play - Spend more time with patients - Nurses want to assess their own children using the tool	- Parents may not understand the importance of “play” during assessment and become impatient and leave - Child may be afraid of the nurse and underperform	- Assessment done in-home - Nurse can teach parents about results when they score the assessment tool	- Nurses distrust accuracy of information reported by parents

^aThe categories “current practice” and “new knowledge” are purposely omitted because there was no comparative data in either of these categories.