Early Literacy Research Library (ELRL) - Article

Early Childhood Learning and the Pediatrician: A Qualitative Study Among Diverse, Low-Income Caregivers

Steinberg, J.R., Bruce, J.S., Marin-Nevarez, P., Phan, K., Merrell, S.B., Chamberlain, L.J. (2018) Early Childhood Learning and the Pediatrician: A Qualitative Study Among Diverse, Low-Income Caregivers. Journal of Developmental & Behavioral Pediatrics, 39(5), 376-386.,

Access: Institutional Access

Publication year


study description

Exploratory, community-engaged, qualitative study.

core topic(s)

Early Literacy , Pediatric Primary Care

Population Characteristics

Medical Providers , Poverty/Low-Income , Toddler/Preschool

Exposures, Outcomes, Other

Community , Libraries and Public Resources , Parent Knowledge, Attitudes, and Beliefs , Provider Behaviors and Skills , School Readiness and Educational Outcomes


This study examined caregivers’ perceptions of ECL (early childhood learning), the role of the pediatrician and pediatric office, and the use of community-based ECL resources among diverse, low-income caregivers whose children were not enrolled in preschool.


Early childhood learning (ECL).

outcomes evaluated

Caregiver perceptions of ECL.


Participants were recruited from low income communities and neighborhoods throughout 2 adjoining counties.


Using community-engaged strategies, caregivers were recruited to participate in in-depth focus groups (FGs). Demographic and FG data were collected in English, Spanish, and Vietnamese. Qualitative data were analyzed with iterative transcript based coding and theme analysis.

sample size

n=12 (focus groups); n=69 (caregivers total); n=46 (mothers); n=8 (fathers); n=15 (grandparents)


Measure of Home ECL: focus groups led by semistructured FG guide was iteratively developed with stakeholder input, sample questions:

    • Please introduce yourself, first name only, and describe how you most enjoy spending time with your child.
    • Can you describe the role of a parent in the life of a young child?
    • Could you please describe the characteristics of a child who is ready for kindergarten
    • Could you tell me what parents can do to help prepare their children for kindergarten?
    • Please describe some of the barriers you or other families in your community face when trying to prepare children for kindergarten.
    • Please describe how, if at all, you think a pediatrician (or other pediatric provider such as a nurse or case manager) could help you prepare your child to be ready for kindergarten.


Additional Measure: anonymous survey with questions regarding demographic characteristics and their home ECL practices, adapted from the California Health Interview Survey and the US Census Bureau with input from community stakeholders.


From June 2015 to August 2015, 69 low-income mothers (n 5 46), fathers (n 5 8), and grandparents (n 5 15) from African-American (33%), Latino (32%), and Vietnamese (35%) communities participated in 12 FGs. Caregivers across groups wanted pediatricians to act as ECL experts and to provide ECL services. Caregivers valued ECL, especially when delivered by trusted sources. Utilization and perception of community ECL resources varied among groups. The greatest variation included different preferences for resource setting, accessibility, and acceptability, especially cultural acceptability. Each individual and groups’ unique, and occasionally adverse, experiences and financial and logistical considerations informed ECL preferences.


This exploratory study brings forth diverse caregivers’ perspectives regarding the role of pediatricians in ECL and their desire for pediatricians to be an access point for high-quality, affordable ECL services. Caregivers’ preferences regarding ECL programming may inform clinic-based pediatric ECL programming.


First, there were limited recruitment venues for 3 Vietnamese focus groups (FGs) and the 2 Latino FGs coordinated with the assistance of community organizations that served limited neighborhoods. We attempted to compensate for this limited recruitment by widely distributing outreach materials among diverse organizations for other Vietnamese and Latino FGs. Second, FG settings can discourage candid conversations about sensitive topics (i.e., immigration status or finances). Despite this limitation, we encouraged open discussions and relied on community cofacilitators to ensure a safe FG environment. Finally, data on the pediatric clinic type that caregivers attended were not addressed as part of this study. The study therefore does not include how the implementation of ECL programming may vary by pediatric clinic type and structure or how caregivers’ pediatric experiences may have varied with clinic type.