Early Literacy Research Library (ELRL) - Article

Latino Parents’ Experiences with Literacy Promotion in Primary Care: Facilitators and Barriers

Jimenez, M.E., et al. (2020) Latino Parents’ Experiences with Literacy Promotion in Primary Care: Facilitators and Barriers. Academic Pediatrics, 20(8), 1177–1183.,

Access: FREE/Open Access

Publication year


study description

Qualitative, semistructured interview study.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Poverty/Low-Income , Race, Ethnicity, and Culture

Exposures, Outcomes, Other

Disparity/Adversity , Parent Knowledge, Attitudes, and Beliefs


We sought to understand literacy promotion from the perspective of Latino parents and to identify facilitators and barriers.


Reach Out and Read (ROR).

outcomes evaluated

Literacy promotion perspectives, facilitators, and barriers.


Study activities occurred at a Federally Qualified Health Center (FQHC) that serves a largely low-income Latino population in New Brunswick, NJ.


We purposively sampled Latino parents who participated in Reach Out and Read (ROR) for a qualitative, semi-structured interview study. We identified themes using immersion/crystallization and achieved thematic saturation after 21 interviews.

sample size

n=21 (interviews)


Measure of Perspectives, Barriers, and Facilitators: qualitative data analysis using field notes, interview transcripts, and debriefing with the community.


Two-thirds of participants had less than high school education; half of whom had not completed 8th grade. The mean child age was 16.4 months. Primary facilitators of engagement were advice from a pediatrician during a clinical encounter and receipt of the ROR book. Barriers identified included: (1) parents’ perceptions that their children were not developmentally ready and that their children’s behavior (e.g., activity) indicated they were not interested in shared reading; (2) self-perceived limited literacy and/or English proficiency; (3) parenting demands occurring in the context of poverty; and (4) continued child media use despite advice from pediatricians to choose alternate activities such as shared reading instead.


Parent-clinician relationships are central to ROR’s impact, but clinicians need to pay more attention to factors in a child’s broader environment to strengthen literacy promotion. Specifically, clinicians should emphasize skill building during the clinical encounter (e.g., sharing knowledge about child development and modeling) and work collaboratively with other stakeholders to address poverty-related stressors.


First, our study focused on Latino parents from one FQHC so our findings may not transfer to all settings. Future work might examine to what extent these themes generalize to other settings and to what extent findings differ across different racial/ethnic, linguistic, and socioeconomic groups. Second, our results may be subject to recall and social desirability bias. We did not observe the clinical visits, so we do not know to what extent providers’ guidance included information on the identified barriers such as child temperament and English proficiency. The goal of this study was to examine the perspective of Latino parents and in doing so elevate the voice of a group whose perspective is too often marginalized. Future work that includes direct observation of the clinical encounter would make an additional contribution. Furthermore, while we assessed participation in ROR at the initial study visit, we do not have information on the number of subsequent ROR visits or books received by parents and therefore cannot examine whether themes differ based on the amount or intensity of ROR exposure. Third, we did not formally assess parents’ English proficiency or literacy level, but the goal of this study was to explore parents’ perspectives on the barriers that they encounter. Fourth, all interviews were conducted by phone which could have potentially limited opportunities for rapport building and observing non-verbal cues.