This study assesses the psychometric properties of the SPARK, a structured interview developed to assess parenting and developmental problems in young children. The inter-rater reliability was found to be very good to excellent, especially for the overall risk assessment and the physical domains. The SPARK showed to be discriminative, by distinguishing between areas with different SES-levels and between postal codes (representing both SES and urbanization). There were clear differences between extreme groups: children reported to the child protective services versus children with positive scores only on all questionnaires. The only psychometric property that was below expectation was the convergent validity. Correlations of SPARK-domains with related domains in the self-reported questionnaires were significant, but very low. Although they showed the expected pattern, no correlation exceeded 0.3. This lack of convergence is probably influenced by several aspects. Firstly, the content and the way of questioning differed quite a lot between the SPARK and the self-report questionnaires. Secondly, the majority of the children had no problems. Thirdly, the group that did not return the questionnaires included a large part of the children with a high risk. Both parents and CHC-nurses were positive about the SPARK. CHC-nurses reported that the SPARK gave practical information and supported them during visits with problem families. They also identified several areas of improvement for the SPARK: its rigid structure and the wording of some questions.
Several authors support our opinion that an assessment of parents’ concerns and their need for support should be done in dialogue with the parents [32
]. One of the main features of the SPARK is direct interaction between parent and professional: the focus is on interactively discussing with parents the child’s needs and development and their needs for parenting support. This professional helps the parent with arranging and judging concerns and problems. The only instrument that has a somewhat similar approach to the SPARK is the Parents’ Evaluations of Developmental Status (PEDS) by Glascoe [33
]. However, there are some major differences between the PEDS and the SPARK. The PEDS is a short 10-item questionnaire to be completed before a visit to a pediatric clinic using a self-report or interview [33
]. The answers are then discussed by the nurse or pediatrician. The SPARK differs from the PEDS in that it is a conversation between parent and professional in order to clarify care needs and to jointly decide on subsequent care. Both the parents and the professional rate their perceived need for support, which is important in situations when parents are avoiding care and to reveal differences in the perceived need between parents and professional. Furthermore, the SPARK has a broader scope, including also the child’s environment. Finally, the SPARK results in an overall assessment of risk for parenting and developmental problems. Whether the SPARK is preferable to self-report questionnaires needs to be determined. The duration of administering the SPARK is about double that of the regular time spent in a visit to the well-baby clinic. This will hamper implementation, in the Netherlands as well as in other countries. Further research is needed on whether implementing the SPARK is cost-effective. Three arguments are in favor of the SPARK: a)
in our current study we observe a response bias, as especially the parents with a child labeled as high risk by the nurse did not return the self-report questionnaires, b)
the interview gives nurses the possibility to ask not only about the child, but also about the (functioning of) the family. Nurses reported that this part in particular gave them new information relevant for deciding which care and support should be offered, and c)
in the Netherlands there is a growing aversion among parents to self-report questionnaires. Parents regard preventive child health care increasingly as a system for detection of child abuse and neglect, instead of as a care provider that supports parents of young children [36
]. This threatens the high reach (>95%) that the Dutch system has traditionally had between 0–4
years. The interactive procedure of the SPARK (i.e. listening to the parent and making a shared decision about subsequent care) may help in re-establishing the trust of parents in preventive child health care.
This study has several limitations. The low convergent validity needs further attention. In addition to the reasons stated above, some other aspects play a role. Firstly, although the response rate for the self-report questionnaires was quite high, there was selective non-reporting: about two-thirds of the children with a label of high risk were part of the one-third that did not return questionnaires. This may have negatively influenced the convergent validity, as the group with expected high scores in both the SPARK and the self-report questionnaires did not contribute to the correlations. Interestingly, this lower response rate showed that the SPARK identifies a large group of children with high risk for parenting problems, which would have been missed by using only self-report questionnaires. Reasons for not returning the questionnaires are unknown, but may include causes as diverse as lack of skills to complete a self-report questionnaire, stress within the family, or not wanting to write about problems within the family. Secondly, we were limited in choosing suitable questionnaires as there is a lack of validated questionnaires for this age group in the Dutch language. Some of the instruments used for assessing the convergent validity have been validated only partially (the KIPPPI, which is used extensively in the Netherlands) or have not been validated for this age group in the Netherlands (ASQ and ASQ:SE). This limits the interpretability of the convergent validity. Thirdly, the lack of convergence may also have been caused by the broad scope of the SPARK compared to the more limited self-report questionnaires.
Another limitation is that, although the province of Zeeland resembles a large part of the Netherlands, it may not be representative of some highly urbanized areas elsewhere in the Netherlands. The validity and feasibility of the SPARK in urbanized, multi-ethnic areas should also be studied. Also, this was a cross-sectional study without follow-up. Further study is required to assess the predictive validity of the SPARK and long-term outcomes.