Contextualization of Harmonized Cognitive Assessment Protocol (HCAP) in an aging population in rural low‐resource settings in Africa: Experiences and strategies adopted to optimize effective adaption of cognitive tests in Kenya

Topic: Risk, prevention and care in population studies

The rural setting presented unique challenges including: low literacy rates (60.1% of participants had no schooling), diverse language use (primarily Giriama and Swahili), limited infrastructure (e.g., 44.8% of households had electricity), restrictive cultural norms that influenced data collection (e.g., in-home interviews were often conducted outdoors with destructions). Key adaptations included: translating and culturally adapting test items (e.g., using local Swahili dialects and culturally relevant examples), recruiting and training local enumerators who were familiar with the community, culture and language, iterative pre-testing and using roleplay helped to ensure that enumerator scoring was consistent, accurate, and reliable. contextualization of tool and data collection strategies included: adjusting data collection methods to accommodate cultural practices and environmental limitations, for example, allowing respondents to use their preferred language for "animal naming," using paper and pen for some test items for which participants experienced difficulty using tablets, paying close special attention to time and season of administration, and adopting strategies to minimize background noise and other environmental distractions (e.g., due to rain, lunch hour, planting and harvesting, and school holidays). Prior to data collection, it was essential to engage local community health volunteers (CHVs), build rapport with participants, explain the study, and describe the idiosyncrasies of cognitive testing. The study emphasizes the importance of cultural sensitivity, linguistic appropriateness, and community engagement in cognitive assessment in diverse, resource-constrained settings. The findings offer practical recommendations for researchers aiming to conduct cognitive assessments in similar populations, contributing to the development of culturally sensitive and effective tools for understanding and addressing cognitive health in aging populations.

Key findings

• The rural setting presented unique challenges including: low literacy rates (60.1% of participants had no schooling), diverse language use (primarily Giriama and Swahili), limited infrastructure (e.g., 44.8% of households had electricity), restrictive cultural norms that influenced data collection (e.g., in-home interviews were often conducted outdoors with destructions).
• Key adaptations included: translating and culturally adapting test items (e.g., using local Swahili dialects and culturally relevant examples), recruiting and training local enumerators who were familiar with the community, culture and language, iterative pre-testing and using roleplay helped to ensure that enumerator scoring was consistent, accurate, and reliable. contextualization of tool and data collection strategies included: adjusting data collection methods to accommodate cultural practices and environmental limitations, for example, allowing respondents to use their preferred language for "animal naming," using paper and pen for some test items for which participants experienced difficulty using tablets, paying close special attention to time and season of administration, and adopting strategies to minimize background noise and other environmental distractions (e.g., due to rain, lunch hour, planting and harvesting, and school holidays).
• Prior to data collection, it was essential to engage local community health volunteers (CHVs), build rapport with participants, explain the study, and describe the idiosyncrasies of cognitive testing.
• The study emphasizes the importance of cultural sensitivity, linguistic appropriateness, and community engagement in cognitive assessment in diverse, resource-constrained settings.
• The findings offer practical recommendations for researchers aiming to conduct cognitive assessments in similar populations, contributing to the development of culturally sensitive and effective tools for understanding and addressing cognitive health in aging populations.

Why it matters

This paper describes strategies for adapting cognitive tests for use in a rural low-resource setting in Kenya. It is about improving assessment methods, not treating, curing, or preventing Alzheimer's disease.

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Study details

• Study designlongitudinal study
• Participants202
• Effect size60.1%; 57.4%; 62.5%
• Evidence strengthModerate

Read the original

• DOI: 10.1002/alz.70552
• PubMed: 40835849
• Original source →
• Free full text: Alzheimer s & Dementia →

Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).

@article{rianga2025-40835849,
  author  = {Riang’a, Roselyter Monchari and Mwangi, Eunice Muthoni and Nagarajan, Niranjani and Agoi, Felix and Mwangala, Patrick Nzivo and Gross, Alden L. and Ikanga, Jean N. and Langa, Kenneth M. and others},
  title   = {{Contextualization of Harmonized Cognitive Assessment Protocol (HCAP) in an aging population in rural low‐resource settings in Africa: Experiences and strategies adopted to optimize effective adaption of cognitive tests in Kenya}},
  journal = {Alzheimer s \& Dementia},
  year    = {2025},
  doi     = {10.1002/alz.70552},
  pmid    = {40835849},
  url     = {https://doi.org/10.1002/alz.70552}
}

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• The mini-mental state examination: a comprehensive review Journal of the American Geriatrics Society · 1992-09-01 · usefulness score 52/100 · Cognitive tests and assessment

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