Abstract
Introduction Cultural adaptation of developmental screening tests often prioritizes psychometric outcomes, overlooking administration-related errors. Yet examiner bias, cultural expectations, and conceptual mismatches can compromise validity before statistical analysis. This study proposes a process-oriented quality assurance model for adapting the Denver II Developmental Screening Test in Kazakhstan. Method Designed as a qualitative case study, the adaptation process was structured using the Plan-Do-Check-Act (PDCA) cycle. Data comprised 117 test administration videos, semi-structured interviews with 10 practitioners, and reviews from five translation experts. Results The analyses revealed two main areas of systematic error: (1) administrators shifting to protective intervention behaviors in line with cultural norms, undermining the objectivity of the test, and (2) direct translation-based instructions not aligning with children's everyday language and conceptual experiences. In response to these problems, neutrality-focused micro-training modules and conceptual adaptations taking into account regional language usage have been developed. Following the intervention process, a more protocol-compliant structure was observed in the application patterns, and it was assessed that the conceptual mappings were restructured to enhance functional alignment. Conclusion This study proposes the ‘Process-Oriented Quality Assurance Model’ as an applicable methodological template not only for the Kazakhstan example but also for other developing countries (LMIC contexts) that are trying to adapt Western-sourced screening tools.