Training of personnel

The candidate designed the study protocol and managed and co-ordinated a team of assessors and fieldworkers. This approach was adopted for several reasons. First, the

number and diversity of assessment procedures required a team approach. Secondly, the candidate is not of Kenyan extraction: if an assessor’s competency in the language of the participant is inadequate, the validity of assessment administration and

interpretation becomes problematic (MacNeill Horton Jr., et al., 2001). Thirdly,

locally-based assessors were able to provide input on the language and the cultural aspects of assessment development. Finally, as described in section 6.8, to increase the chance o f assessment results that are representative o f the child’s actual abilities, it is necessary reduce the number of unfamiliar aspects o f the assessment situation, which includes recruiting team members from the same ethnic group as the target population. The involvement of carefully selected assessors reduces the possibility of sources of conflict in cultural assumptions and communicative norms prior to the assessment procedure (Pakendorf and Alant, 1997). The roles and training of the assessment team are detailed below.

8.4.1 Speech and language assessments

Two assessors and three fieldworkers, all from the Mijikenda ethnic group, were responsible for collecting speech and language data. The assessors carried out the comprehension, syntax, higher level language and word finding assessments and

recorded the spontaneous language sample and word finding test. One of the

fieldworkers was responsible for the phonetic transcription o f the word finding sample for use in the phonological assessment and the orthographic transcription of the spontaneous language sample. The latter was profiled by the assessor who had collected the sample for the lexical semantics assessment.

The other two fieldworkers were responsible for conducting the parental pragmatics questionnaire in addition to the parental behaviour questionnaire and collecting socioeconomic data.

Assessors and fieldworkers were trained by the candidate before data collection began. One o f the assessors was trained before the pilot study (section 10.4). The other assessor had previously worked at the Education and Assessment Resources Service and had some experience o f paediatric speech and language testing, thus required a shorter period o f training. Training was divided into three stages. First,

teaching sessions were held on language acquisition, the facets of speech and language forming the theoretical framework of the study (described in Chapter Nine), speech and language pathology and assessment techniques, emphasising the particular

principles of assessment in the context of research methodology. Secondly, the

assessors contributed to aspects of the design and refinement o f the assessment battery. Finally, practice assessment sessions, observed by the candidate, were carried out with children from the target population. Feedback and discussion took place after each session.

The fieldworker responsible for transcription was already familiar with the International Phonetic Alphabet so his training comprised a ‘refresher’ course on phonetic transcription and practical work on transcription methods. The fieldworkers responsible for conducting parental questionnaires underwent training in interview techniques, recording and scoring responses. Practice interviews, observed by the candidate, were held with mothers recruited from the out-patient department of Kilifi District Hospital (KDH). Discussion and feedback took place after each interview.

The candidate designed instruction manuals for the speech and language assessments (Appendix 8). They were inserted at the beginning of each assessment booklet so they were available for reference at any time during the course of the study.

8.4.2 Cognitive assessment

Two assessors were responsible for carrying out the cognitive assessment. One

assessor was o f Mijikenda origin and the other was from another ethnic group but had lived in the area for many years and could speak Kigiryama. Both assessors had previous experience o f conducting cognitive assessments and were involved in the

development and adaptation of the assessments. Specific training in the tasks

employed in the current study was carried out by an educational psychologist based at KEMRI (Dr P Holding). An instruction manual for the cognitive assessment was available for reference during the study.

8.4.3 Behaviour questionnaire

The behaviour questionnaire was administered to parents by the two fieldworkers also responsible for carrying out the pragmatics questionnaire. Their general training is described in the speech and language assessment section (section 8.4.1). Additional training on the specifics of the behaviour questionnaire was carried out by an educational psychologist based at the KEMRI unit (Dr P Holding), Avith assistance from the candidate. The fieldworkers did not have direct contact with the children to ensure that all assessors were blind to the group status of the study participants.

8.4.4 Neurological assessment/epilepsy questionnaire

The neurological assessment and parental questionnaire on epilepsy were conducted in

the same session by one of two unit physicians. Both underwent training in

neurological examination from an experienced Paediatric Neurologist (Dr C Newton) and were observed performing the examination in several practice sessions.

8.4.5 Electroencephalogram

The EEG was carried out by a trained unit technician and was independently read by an experienced Paediatric Neurophysiologist (Dr S White) visiting from Great Ormond Street Hospital in London, UK. The unit technician was a Clinical Officer who had received six weeks of training in neurophysiology at Kenyatta Hospital, Nairobi, Kenya and a further four weeks at the Neurophysiology Department o f Great

Ormond Street Hospital, London, UK. He received on-site supervision from a

Paediatric Neurologist and the visiting Paediatric Neurophysiologist.

8.4.6 Vision and hearing tests

The candidate carried out the majority of the hearing and vision tests. However, one o f the fieldworkers from the language team was trained by the candidate in the techniques o f audiometry and visual screening, in order that two assessors were available. The training involved theoretical sessions on assessment techniques for children, the background to the tests chosen for the study and specific training on recording audiometric results. Observed practical sessions were carried out with

children from the target population with opportunity for discussion and feedback after each session.

8.4.7 Recruitment o f participants

A demographer identified all participants from unit databases. Children were

recruited by a fieldworker who had received training in locating rural-based children using maps produced in a previous census study. The fieldworker also collected

demographic data on each participant. Both the demographer and fieldworker

remained separate from the assessment process to preserve the integrity of the ‘blinding’ of the assessors to the group status of each participant.

8.4.8 Quality assessment

A system of cross-checking was instigated whereby pairs o f assessors would check each other’s assessment forms for accuracy, missing scores and inconsistencies. The candidate would carry out a final cross-check when collating each child’s file. Weekly trouble-shooting meetings were held throughout the course o f data collection, during which the candidate updated the team on the progress o f the study and each team member was given the opportunity to raise issues and problems for discussion.

‘Assessment refresher days’ for the cognitive and language assessors were organised periodically by the candidate to ensure the standard of assessment practice was maintained and to give the team an opportunity to reflect on their own and each other’s performances. Each day was divided into three sessions: first, observation of assessments (with each assessor performing and observing at least one assessment), second, discussion of general assessment principles and techniques and finally, presentation o f case studies and problem solving. In addition, the candidate carried out regular observations of the assessors to supplement this process.