Early Literacy Research Library (ELRL) - Article

Reading to the Preterm Infant: Parent Perspectives on Barriers and Facilitators

Hill, M.E., Martin, A., DeMauro, S.B. (2023) Reading to the Preterm Infant: Parent Perspectives on Barriers and Facilitators. Academic Pediatrics, 23(1), 148-154.,

Access: Institutional Access

Publication year


study description

Qualitative Cohort Study, Semi-structured interview

core topic(s)

Shared Reading

Population Characteristics

Infant/Newborn , Neonatal/NICU

Exposures, Outcomes, Other

Disparity/Adversity , Parent Behaviors and Skills , Parent Knowledge, Attitudes, and Beliefs


To describe parent-reported barriers and facilitators to reading to preterm-born infants, both in the neonatal intensive care unit (NICU) and at home.


Reading to pre-term infants

outcomes evaluated

Barriers and facilitators


Study participants were parents of infants scheduled for routine clinical care in the Neonatal Follow-up Program (NFP) at the Buerger Center for Advanced Pediatric Care at Children’s Hospital of Philadelphia between November 2019 and May 2020. Infants were previously cared for in one of three tertiary/quaternary hospital NICUs in Philadelphia.


We performed a qualitative study of parents of 0-12 month corrected age infants presenting to neonatal follow-up clinic. Infants were born <33 weeks gestational age or with birth weight ≤1500 grams. Parents completed a semi-structured interview about reading practices. Answers to open-ended questions were coded to highlight key themes.

sample size

n=23 (parents); n=28 (infants)


Qualitative thematic analysis


We reached thematic saturation after interviewing 23 parents of 28 infants. Parent-generated items about barriers and facilitators to reading in the NICU and at home were each coded into four themes. Competing responsibilities and believing that reading was developmentally inappropriate were two shared themes for barriers to reading in both the NICU and home environment. Support people and understanding developmental impact were two shared themes for facilitators to reading in both the NICU and home environment.


This qualitative work elucidates new targets for novel programs intended to support cognitive development of high-risk preterm infants. Addressing the unique, parent-reported barriers that we have identified and supporting adoption of the facilitators could increase word exposure for preterm infants, starting in the NICU and continuing at home.


Fathers’ perspectives are underrepresented as 22 of 23 parents interviewed were mothers. Non-English-speaking families are also not represented, and we recognize that this population may have a unique set of barriers and facilitators to reading. Parents may overreport reading and be reluctant to describe barriers out of fear of being perceived as uncaring about their infants’ development. However, open-ended and probing questions helped to overcome these limitations, as did conducting the interviews after the medical visit and typically within the comfort of the parents’ homes. Additionally, while we reached thematic saturation with enrollment of 28 subjects, this number of subjects provides insufficient power for quantitative comparisons of StimQ-Infant scores or other factors between subgroups of our cohort. In balance, semi-structured interviews allowed perspectives of a diverse group of parents to be explored in detail. Our participants represented diverse socioeconomic and demographic backgrounds and were generally representative of the population of patients cared for in our follow-up clinic. We enrolled both working and not working parents as well as parents of various educational backgrounds, which improves the generalizability of our results. Additionally, having 17% of the study population comprised of families who did not attend their first scheduled neonatal follow-up appointment provides the important, but often unmeasured, perspective of a subset of families who may be facing unique challenges.