Literacy Promotion in Primary Care Pediatrics: Can We Make a Difference?

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Publication year

2000

study description

Randomized, prospective, intervention study.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Poverty/Low-Income , Toddler/Preschool , Urban

Exposures, Outcomes, Other

Language and Literacy Development , Parent Behaviors and Skills , Parent Knowledge, Attitudes, and Beliefs

metric(s)

MacArthur-Bates Communicative Development Inventories (MB-CDI)

objectives

To evaluate the effects of a literacy promoting intervention delivered by pediatric providers as part of well-child care on parent attitudes and behaviors and on child language.

exposure

Reach Out and Read (ROR)

outcomes evaluated

Parent attitudes and behaviors, child language outcomes, and family child centered literacy orientation (CCLO).

setting

Urban community-based health centers for pediatric care serving a low income multiethnic population.

methods

A multicultural group of 205 low-income families with 5- to 11-month-olds were prospectively enrolled, interviewed, and randomized to intervention (n 5 106) or control (n 5 99) groups. Families in the intervention group received developmentally appropriate children’s books and educational materials and advice about sharing books with children, while those in the control group received no books or materials relevant to literacy. After an average of 3.4 well-child visits in both groups, 153 (75%) were reinterviewed and the children’s receptive and expressive vocabulary was tested using a modified version of the MacArthur Communication and Development Inventory (Short Form). Parents were asked if their child understood (receptive vocabulary) or said (expressive vocabulary) each of 100 words, half of which were in the books given. Families were found to have a Child-Centered Literacy Orientation if they mentioned reading aloud as one of their child’s favorite activities or as one of their own favorite joint activities or if they usually read together at bedtime. At follow-up toddlers were 18.4 months old on average.

sample size

n=106 (intervention); n=99 (control); n=205 (total)

measures

Measure of Parent Attitudes and Behaviors: interview.

 

Measure of Receptive and Expressive Vocabulary: modified version of the MacArthur Communication and Development Inventory (short form).

 

Measure of Child Centered Literacy Orientation (CCLO): whether or not families mentioned reading aloud as one of their child’s favorite activities or as one of their own favorite joint activities or if they usually read together at bedtime.

results

Intervention and control groups had similar literacy related characteristics at baseline. There was a 40% increase in Child-Centered Literacy Orientation among intervention families compared with 16% among controls. Intervention families read more with their toddlers (4.3 vs 3.8 days/week). Both receptive and expressive vocabulary scores were higher in older intervention toddlers (18–25 months old; n 5 88), but not in younger intervention toddlers (13–17 months old; n 5 62). This significant effect of the intervention on vocabulary scores in older toddlers was found for both the 50 words in the books and those not in the books. After parent education, foreign birth and language proficiency, and child age were statistically controlled, the intervention remained significantly associated with higher language outcomes in older toddlers. However, when reading aloud was added to the multivariate analysis, the influence of the intervention was no longer evident, suggesting the intervention’s effect on child language was mediated through increased shared reading with these toddlers.

conclusions

This simple and inexpensive intervention, delivered as part of well-child care, changed parent attitudes toward the importance of reading with their infants and toddlers. These intervention parents and their children read more together and this was associated with enhanced language development in older toddlers in this diverse group of low-income families.

limitations

"One limitation of this study was our failure to achieve equivalent distributions in demographic variables in intervention and control groups at follow-up. The overrepresentation of higher parental education in control parents should bias the results in the direction contrary to the hypothesis. Another limitation of this study was the attrition of 25% of the enrolled sample...A third limitation of our study was that all outcome measures were based on data obtained by parental report...Another limitation that relates to our language outcome measure was that we did not use a standardized and validated instrument to measure these skills...Another limitation of this work was that although the 6 research assistants who performed follow-up interviews were blind to a family's group assignment, they were not blind to the study hypothesis. Parents revealed their attitudes and practices around literacy early in the interview, before providing responses to the modified MacArthur vocabulary tests. This could potentially influence interviewers to skew vocabulary data in the direction of the hypothesis."