Early Literacy Research Library (ELRL) - Article

Promoting Early Literacy Using Digital Devices: A Pilot Randomized Controlled Trial

Guevara, J.P., Erkoboni, D., Gerdes, M., Winston, S., Sands, D., Rogers, K., Haecker, T., Jimenez, M.E., Mendelsohn, A.L. (2021) Promoting Early Literacy Using Digital Devices: A Pilot Randomized Controlled Trial. Academic Pediatrics, 21(6), 1001-1008.,

Access: Institutional Access

Publication year


study description

Pilot randomized controlled trial.

core topic(s)

Early Literacy

Population Characteristics


Exposures, Outcomes, Other

Child Development (general) , Clinic-Based Programs and Interventions , Home Language/Literacy/Learning Environment , Implementation and Evaluation , Language and Literacy Development , Technology and Digital/Screen-Based Media , Validity, Reliability, Feasibility, and Acceptability


To determine feasibility and explore effects of literacy promotion using e-books versus board books on the home reading environment, book reading, television use, and child development.


Digital literacy promotion (DLP) using e-books.

outcomes evaluated

Child language development.


The study was conducted at 3 primary care pediatric practices located in the Philadelphia metropolitan area from April 17, 2017 to December 31, 2018. The practices served a diversity of children from urban predominantly Black to suburban predominantly White patient populations.


Randomized controlled trial comparing digital literacy promotion (DLP) using e-books to standard literacy promotion (SLP) using board books among Medicaid-eligible infants. DLP participants received e-books on home digital devices, while SLP participants received board books at well visits between 6 and 12 months of age. Differences in StimQ Read Subscale (StimQ-Read) scores, parent-reported reading and television use, and Bayley Scales of Infant Development3rd Edition (Bayley-3) scores between groups were assessed using intention-to-treat analysis.

sample size

n=104 (infants); n=3 (pediatric practices)


Measure of Feasibility: proportion of children in each arm who received books and followed counseling on reading promotion at well visits.


Measure of Child Language Development: Bayley Scales of Infant Development 3rd Edition (Bayley-3), a validated measure of early child development for children 1 to 42 months of age. The Bayley contains separate scales for cognitive, language, and motor development with the focus of our study being on the language scale.


Measure of Reading and Media Use: parent reported frequency of board book reading, e-book reading, and television viewing with their infants via REDcap survey.


Measure of Home Reading Environment: StimQ Read Subscale assessed parent reported reading activities and book variety at home via REDcap survey.


Measures of Potential Confounding Factors:

    • Childhood Adversity: 9-item Adverse Childhood Experiences questionnaire
    • Maternal Health Literacy: Short Assessment of Health Literacy (SAHL)
    • Maternal Depression: Edinburgh Postnatal Depression Scale


A total of 104 Medicaid-eligible infants were enrolled and randomized from 3 pediatric practices. There were no differences in sociodemographic characteristics between groups at baseline. Children in the DLP group initially had lower StimQ-Read scores but showed similar increases in StimQ-Read scores over time as children in the SLP group. Parents in the DLP group reported greater use of digital devices to read or engage their child (65% vs 23%, P < .001) but similar board book reading and television viewing. There were no differences between groups in cognitive or motor scale scores, but DLP participants had marginally lower language scales scores (DLP 85.7 vs SLP 89.7; P = .10) at the 6-month follow-up.


Literacy promotion using ebooks was feasible and associated with greater e-book usage but no difference in board book reading, television viewing, or home reading environment scores. A potential adverse impact of e-books on language development should be confirmed in future study.


First, our sample was drawn from an integrated pediatric health system in a single geographic area. The reading behaviors of these parents may not be generalizable to low-income parents elsewhere. Second, we did not measure overall digital media use among infants. Therefore, e-book reading may have encouraged other media use including games and video apps that could have contributed to lower language scores. Third, we relied on parent report of reading behaviors. We did not observe parent-child reading behaviors to assess interactions while reading or verify if parents used the e-books and board books provided or mailed to them. A majority of parents in both groups, however, reported employing dialogic reading techniques. Fourth, parents in the e-book arm downloaded the apps onto either computer tablets or phones, which may have limited the size of the screen available for viewing. Fifth, we were unable to conduct Bayley-3 testing at the outset of the study to ensure equivalent developmental status between groups at the start. However, given that we randomized participants and excluded infants who were likely to have a developmental delay, we feel that it would have been highly unlikely to have differences in developmental status at the outset. Finally, our sample size was underpowered to identify a statistically significant difference in Bayley-3 language or StimQ-Read scores. Future studies with larger samples sizes will be necessary to confirm any differences in language or home reading environment scores found in this study.