Enhancing Parent Talk, Reading, and Play in Primary Care: Sustained Impacts of the Video Interaction Project

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Publication year

2018

study description

Randomized controlled trial.

core topic(s)

Early Relational Health , Pediatric Primary Care , Shared Reading

Population Characteristics

Immigrant , Poverty/Low-Income , Urban

Exposures, Outcomes, Other

Building Blocks , Child Behaviors and Skills , Clinic-Based Programs and Interventions , Parent Behaviors and Skills , Play , Programs and Interventions (other) , Video Interaction Project

metric(s)

StimQ Cognitive Home Environment Questionnaire (StimQ)
Woodcock Johnson Tests (WJ)

objectives

To determine the early impacts of pediatric primary care parenting interventions on parent cognitive stimulation in low socioeconomic status families and whether these impacts are sustained up to 1.5 years after program completion.

exposure

Interventions: Video Interaction Project (VIP) or Building Blocks (BB).

outcomes evaluated

Parental cognitive stimulation.

setting

Enrollment was performed in the postpartum ward of an inner-city public hospital (Bellevue Hospital Center) serving low SES, primarily immigrant families, between November 2005 and October 2008.

methods

This randomized controlled trial included assignment to 1 of 2 interventions (Video Interaction Project [VIP] or Building Blocks) or to a control group. Mother–newborn dyads were enrolled postpartum in an urban public hospital. In VIP, dyads met with an interventionist on days of well-child visits; the interventionist facilitated interactions in play and shared reading through provision of learning materials and review of videotaped parent–child interactions. In Building Blocks, parents were mailed parenting pamphlets and learning materials. We compare the trajectories of cognitive stimulation for parents in VIP and control from 6 to 54 months.

sample size

n=546 (families)

measures

Baseline Measures: parental interview at enrollment assessed parent and family sociodemographic information and maternal language/literacy in her preferred language using the Woodcock-Johnson III21/Bateria III Woodcock-Muñoz Tests of Achievement, and the Letter-Word Identification Test.

 

Measure of Cognitive Stimulation: assessed in the context of play, shared reading, and daily routines using the StimQ2-Infant (StimQ2-I) at child age 6months, the StimQ2-Toddler (StimQ2- T) at child ages 14 and 24 months, and the StimQ2-Preschool (StimQ2-P) at ages 36 and 54 months.

 

Measure of Parent Verbal Input: assessed in the context of videotaped shared book reading interactions for:

• • Utterances (total number of idea units verbally uttered by mother).
  • Word Types (total number of different words used by the mother).
  • Word Tokens (total number of words used by the mother).

results

There were 546 families that contributed data. VIP was associated with enhanced reading, parent verbal responsivity, and overall stimulation at all assessment points, with analyses demonstrating a 0.38 standard deviation increase in cognitive stimulation overall. Trajectory models indicated long-term persistence of VIP impacts on reading, teaching, and verbal responsivity.

conclusions

VIP is associated with sustained enhancements in cognitive stimulation in the home 1.5 years after completion of the program and support expansion of pediatric interventions to enhance developmental trajectories of children of low socioeconomic status.

limitations

First, owing to limitations in resources, we were unable to follow BB fully beyond 14 months, or at all beyond 24 months. The smaller sample size of the BB group at 24 months may have left analyses underpowered to detect impacts of BB at this timepoint. Second, results at 6-36 months were based entirely on parent report, which, despite being obtained from measures that are reliable and valid, can be subject to biases. However, results converged with observed measures of verbal input at 54months in shared book reading interactions. Third, participating mothers were primarily first generation, Hispanic/Latina immigrants, and results therefore may not generalize to families with other sociodemographic characteristics.