A BEHAVIORAL CULTURAL SERVICE INTEGRATION MODEL (ADELIA) FOR EARLY LANGUAGE DEVELOPMENT DETECTION IN LOW-RESOURCE COASTAL SETTINGS: A MIXED-METHODS STUDY

Abstract

Early detection of language delay remains a major challenge in low-resource settings, where parental recognition of developmental milestones is often limited by socio-cultural and health system constraints. Limited awareness and delayed help-seeking behavior contribute to poor developmental outcomes among children, particularly in underserved populations. This study aimed to identify determinants of parental ability to recognize early language development and to develop an integrated empowerment model (ADELIA). A sequential explanatory mixed-methods design was conducted in a coastal area of Indonesia involving 304 parents. Quantitative data were analyzed using multivariable logistic regression, while qualitative data from in-depth interviews were analyzed thematically. A total of 67.4% of parents were unable to recognize age-appropriate language milestones. Significant determinants included education (OR=52.076; p=0.003), knowledge (OR=0.056; p=0.008), attitude (OR=81.587; p<0.001), culture (OR=0.031; p=0.008), and SDIDTK utilization (OR=32.766; p=0.004). Attitude emerged as the strongest predictor. Qualitative findings revealed normalization of speech delay, limited awareness, and structural barriers in service delivery. Parental ability is shaped by a complex interaction of behavioral, cultural, and system-level factors. The ADELIA model provides a multi-level and context-sensitive framework to bridge the gap between awareness and action in early detection.