LEKSHIA-Sleep Disturbance Scale for Children: A simplified and culturally adapted pediatric sleep screening tool for use by community health workers.

BACKGROUND

Children's sleep disturbances are not well understood, especially in the community settings where access to specialized care is limited. Although thorough, the Sleep Disturbance Scale for Children (SDSC) might be too difficult for frontline healthcare providers to administer. The purpose of this study was to develop LEKSHIA-SDSC, a streamlined and culturally appropriate 10-item version of the SDSC, available in both English and Malayalam, and specifically designed for use by Indian community health workers.

METHODOLOGY: A two-phase modification process was carried out building on the SDSC's previously established factorial structure, interrater reliability, and content validity. Expert-guided item reduction, literacy-focused rewording, and behavioral observability-based resequencing (from sleep onset to daytime symptoms) were all carried out in Phase I. In Phase II, the previously created Malayalam version of the SDSC was adapted for the shortened tool. As the original translation had undergone forward-backward translation, expert review, and cognitive debriefing, only minimal rewording of two items was required based on fresh caregiver feedback to improve clarity and contextual fit.

RESULTS

The final LEKSHIA-SDSC tool has 10 streamlined items with a 4-point Likert scale (0-3), resulting in a score range of 0-30. The definitions of risk thresholds were changed to 0-8 (low risk), 9-15 (mild risk), and ≥ 16 (high risk). Strong prior content validity (item-level content validity index ≥0.78) and high inter-rater agreement (Kappa > 0.85) were demonstrated by the items that were kept. Caregivers' comments affirmed the tool's usability and suitability for low-literacy environments.

CONCLUSION

LEKSHIA-SDSC is a simple and culturally appropriate pediatric sleep screening instrument that can be incorporated into regular community health screening initiatives.