{
  "abstract": "Objectives Share lessons learned from implementing the HOME Scale (Home Observation Measurement of the Environment) in Indigenous communities in Guatemala as part of a clinical trial.Methods The HOME Scale measures the child’s home environment, focusing on support and stimulation received. It includes 45 items for children under age 3 and 55 items for older children. The scale is administered with the primary caregiver in the home, with items verified through observation, questioning, or both. After coding, we documented lessons learned from implementation, including challenges encountered and solutions applied.Results From January 2023 to July 2025, the HOME Scale was administered with 311 families across six departments (Quiché, Sololá, Chimaltenango, Suchitepéquez, Sacatepéquez, and Guatemala). Families sometimes lacked the exact item referenced, but when the purpose was explained, alternatives were often identified. For example, colors were taught using threads for weaving güipiles. While specific items may not exist, families frequently had culturally relevant substitutes that should be acknowledged as valid.Conclusions We successfully implemented the HOME Scale in rural Guatemalan communities. Although not originally designed for this context, the tool proved understandable and relevant. Administering the scale in Mayan languages was particularly valuable, improving caregiver comprehension and yielding more authentic assessments.",
  "authors": [
    {
      "affiliations": [
        "Center for Indigenous Health Research, Maya Health Alliance, Tecpán, Guatemala"
      ],
      "name": "Rosa Rabinal"
    },
    {
      "affiliations": [
        "Center for Indigenous Health Research, Maya Health Alliance, Guatemala, Guatemala"
      ],
      "name": "Sara Hernandez"
    },
    {
      "affiliations": [
        "Center for Indigenous Health Research, Maya Health Alliance, Tecpán, Guatemala"
      ],
      "name": "Scott Tschida"
    },
    {
      "affiliations": [
        "Center for Indigenous Health Research, Maya Health Alliance, Tecpán, Guatemala"
      ],
      "name": "Magdalena Guarchaj"
    },
    {
      "affiliations": [
        "Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, USA",
        "Division of Developmental-Behavioral Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA",
        "Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA"
      ],
      "name": "Beth A Smith"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA",
        "Division of Global Health Equity, Brigham and Women’s Hospital, Boston, USA",
        "Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA"
      ],
      "name": "Peter Rohloff"
    }
  ],
  "title": "188 Lessons learned from implementing the HOME scale in indigenous communities of Guatemala",
  "uid": "36ac8657-8620-55ba-ae36-706b31837537"
}