Early Literacy Research Library (ELRL) - Article

Prescribing Books for Preschoolers under Comprehensive Child Development Service in Hong Kong East: A Pilot Study

Wong, W.K.W. (2022) Prescribing Books for Preschoolers Under Comprehensive Child Development in Hong Kong East: A Pilot Study. Hong Kong Journal of Paediatrics (New Series), 27(1), 3-9.,

Access: FREE/Open Access

Publication year


study description


core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Infant/Newborn , International , Toddler/Preschool

Exposures, Outcomes, Other

Child Development (general) , Disparity/Adversity , Home Language/Literacy/Learning Environment , Mental Health , Positive Parenting


To determine if book prescription by paediatrician at community-based clinics can improve literacy orientation and home literacy environment in high-risk families.


Reach Out and Read (ROR).

outcomes evaluated

Literacy orientation and home literacy environment (HLE).


Parents of children aged 6 to 30 months born from mothers suffering from active mental or mood disorder, substance misuse or teenage pregnancy under CCDS attending pediatric on-site clinic at Maternal & Child Health Centres (MCHC) in Hong Kong East, namely Chai Wan, Sai Wan Ho and North Point MCHC in April and May 2017.


70 at risk children under Comprehensive Child Development Service aged from 6 to 30 months received book prescription from April to December 2017. Questionnaires on reading aloud were completed by parents just before the intervention and then 6 months later.

sample size

n=70 (children)


Measures of Literacy Orientation and Home Environment: a questionnaire was designed with reference to assessment tools used in previous studies on literacy orientation, child-centered literacy orientation and home literacy environment. It contained 4 questions in Chinese (with English translation):

    1. Did you read aloud with your child in the past 24 hours?
    2. How many children books do you have at home?
    3. How many times do you read with your child per week in average?
    4. What are your child’s top three favourite activities?


Before book prescription, 25.7% of parents read book with their child and 17.1% chose reading book with their child as top three preferred activities. After the intervention, the corresponding figures significantly increased to 54.3% and 51.4% (p-values <0.001) respectively. Parents read more frequently with their child every week (p-values <0.001) and had more books at home after intervention (p-values <0.001).


Book prescription by paediatrician at community-based clinics can be an effective strategy in promoting positive parenting and early literacy development for high-risk children locally.


The major limitation of this study was the lack of a control group and no reference for comparing the effect of book prescription with no intervention. Nonetheless, the study findings were comparable with post-intervention group of similar studies in other countries. High-risk families were known to have poor compliance to clinical visits and in the present study the default rate was 32%. These default subjects may represent even higher risk group with more adverse factors and future study on evaluating them was valuable. Relative small sample size can result in error on subgroup analysis of subjects with small numbers. Besides, results based on self-reporting only assessed perception but not behaviour and can be subjected to biases. Home visitation with direct counting of books at home may get more objective and valid data. Other objective measures to assess the improvement of actual literacy rate and the developmental milestone on the long-term effect of language development, reading abilities and school achievement should be used in future studies. Besides, a longer intervention and study period is needed for more books to be prescribed and better reflection on its long-term effect.