Cultural Adaptation and Linguistic Validation of a Community-Based Autism Screening Tools for Early Identification in Tanzania: A Mixed-Methods Study

Background: In Tanzania and many other resource-limited settings, early diagnosis of Autism Spectrum Disorder (ASD) is often delayed due to a lack of culturally validated screening tools. Most available ASD screening tools were developed in Western countries and may not reflect local cultural and linguistic contexts. Purpose: This study aimed to culturally adapt and linguistically validate the Swahili versions of both the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT R/F) and the Social Communication Questionnaire (SCQ) for use in the Tanzanian context. Methods: A sequential mixed-methods study was conducted in Moshi Municipality and Hai District, Kilimanjaro Region, Tanzania. The study involved translation, cross-cultural adaptation, cognitive debriefing, expert panel review, and pilot testing of the psychometric evaluation of the M-CHAT R/F and SCQ. Qualitative interviews and focus group discussions explored comprehension and contextual appropriateness of the tools. Pilot testing involved 32 caregivers of children aged 1-8 years. Internal consistency was assessed using Cronbach's alpha and KR-20. Results: Participants found both the adapted tools understandable and culturally appropriate. Unfamiliar examples, such as vacuum cleaners and dinosaurs, were replaced with locally familiar examples including domestic animals, loud music, and vehicle sounds. The M-CHATR/F demonstrated acceptable internal consistency (Cronbach's alpha = 0.77; KR-20 = 0.79), while the SCQ showed good reliability (Cronbach's alpha= 0.83; KR-20 = 0.84). Cognitive debriefing and expert review confirmed the clarity and comprehension of the adapted tools for community use. Conclusion: The adapted Swahili versions of the M-CHAT R/F and SCQ demonstrated promising preliminary reliability and cultural relevance for ASD screening in Tanzania. These findings support the use of culturally tailored screening tools to improve early identification and referral of children with ASD in Tanzania. Keywords: Autism Spectrum Disorder, Cultural adaptation, M-CHAT R/F, SCQ, Swahili, Screening tools