Intended Outcomes and Core Components of Primary Care-Based Literacy Promotion as Defined by Experts

Access: FREE/Open Access

Publication year

2025

study description

Expert-informed qualitative study

objectives

Primary care-based literacy promotion enhances caregiver-child shared reading and child language outcomes, yet variation in implementation may dilute its impact. This study examines expert perspectives on intended outcomes of literacy promotion, as well as its core components, those necessary to achieve intended outcomes, and components that are recommended but adaptable to context.

exposure

Primary care-based literacy promotion

outcomes evaluated

Intended outcomes of literacy promotion, as well as its core components, those necessary to achieve intended outcomes, and components that are recommended but adaptable to context

setting

U.S. and Canada

methods

We purposively sampled healthcare and policy experts in primary care-based literacy promotion from the U.S. and Canada for online, in-depth interviews. Interviews were recorded, transcribed verbatim, and analyzed iteratively engaging emergent and a priori codes based on the COmponents and Rationales for Effectiveness Fidelity Method and the team’s prior work to identify themes.

sample size

N = 22 experts

measures

Qualitative themes analysis

results

We achieved saturation after 22 interviews with 24 participants (16 U.S. participants, 8 Canadian). We identified four themes: 1) Traditionally, literacy promotion focused on enhancing preliteracy skills and school readiness. Over time, this outcome has evolved to include fostering early relational health as a foundational goal; 2) Core components include a trusted clinician delivering a strength-based, family-centered message, while modeling developmentally-informed shared reading; 3) Components that are adaptable to setting and context include literacy-rich clinical environments and community resource referrals; 4) Experts diverged on whether providing a children’s book during literacy promotion is essential, but there was congruence that book provision alone is insufficient.

conclusions

Experts identified strength-based, family-centered guidance from a trusted clinician with developmentally-focused modeling as core to support intended outcomes of early relational health and school readiness. This understanding can inform training and healthcare improvement activities aimed at optimizing primary care-based literacy promotion.

limitations

We focused on interviewing healthcare and policy experts as a first step to understanding primary care-based literacy promotion as intended. While these perspectives are useful and important, they may differ from the perspectives of frontline clinicians, educators, other professionals, and caregivers which should be the focus of future work. Additionally, while the perspectives of experts on core components enhances our understanding and generates useful hypotheses, empirical work examining components and mechanisms of action is needed.