Document resource
Objectives Share lessons learned from implementing the Nursing Child Assessment Satellite Training (NCAST) scale in rural areas of Guatemala.Methods As part of a clinical trial, we implemented NCAST with primary caregivers to evaluate caregiver–infant interaction during feeding. Assessments were conducted in the caregiver’s home at four time points (newborn, 6, 12, and 18 months). Throughout the trial, the team met regularly to discuss and address challenges that arose.Results From January 2024 to July 2025, 217 NCAST assessments were completed with caregivers and their infants. Initially, caregivers often avoided interacting with their babies, hid their faces while being recorded, or detached their infants from the breast to end the video. As infants grew, they began noticing our presence, which distracted them. Our solution was to move to a space where the infant could not see us, allowing caregiver–infant interaction to occur more naturally. Caregivers also expressed embarrassment about the food they provided. At times, infants had already been fed; to address this, we began scheduling visits according to caregivers’ reported feeding times.Conclusions Although NCAST was originally developed in the United States, we successfully adapted it to support authentic caregiver–infant interactions. Our experience demonstrates the feasibility of implementing NCAST in rural Guatemalan settings.