Parent Perspectives on the Usability and Accessibility of the Cdc Milestone Checklist and Asq-3 Questionnaire in Monitoring Early Developmental Delays

Background Early identification of developmental delays is pivotal for timely intervention and optimal child outcomes. Parent-administered tools such as the CDC Milestone Checklist and Ages and Stages Questionnaire–3 (ASQ-3) are globally used; however, their usability and accessibility among Indian parents, particularly those with varying literacy levels, remain underexplored Objective To evaluate and compare the usability and accessibility of the CDC Milestone Checklist and ASQ-3 among parents. Methods A sequential mixed-methods design was implemented. Phase I- a pilot study with 60 parents (30 per tool) to establish baseline usability and accessibility. Phase II- qualitative interviews with 17 parents, where both tools were administered and analysed thematically. In Phase III, a within-subject quantitative study with 84 parents, participants completed both tools were assessed using a structured Likert scale. Results The study reveals CDC Checklist was easier to understand, with 65.5% deriving more than five developmental cues, compared to the ASQ-3, where 53.5% found it difficult to understand and 39.2% required more than five cues. Familiarity with the CDC Checklist was lower initially (39% unfamiliar), but none reported unfamiliarity with the ASQ-3 when administered a second. Higher curiosity of ASQ-3 (65.5% very curious) but took longer to complete (62%: 15–20 min; 26%: >20 min). First-time mothers (46.7%) and parents of preterm infants (46.7%) faced greater challenges with comprehension and scoring, though less so with the CDC Checklist. Conclusion While both tools have value, the CDC Checklist aligned more closely with parental perspectives due to its simplicity and clarity, while practical barriers were found in using both tools in the Indian context. Findings underscore the need for a culturally sensitive and linguistically accessible developmental screening tool tailored for Indian parents.