Early Literacy Research Library (ELRL) - Article

Ready and Healthy for Kindergarten: a Bilingual Family Literacy Program in Primary Care

Shelton, P.A., Morrow, L.M., Lima, D., Maskey-Pagodin, A., Pai, S., Ramachandran, U., Jimenez, M.E. (2021) Ready and Healthy for Kindergarten: A Bilingual Family Literacy Program in Primary Care. Maternal and Child Health Journal, 25(4), 521–527.,

Access: FREE/Open Access

Publication year


study description

Program development and single-arm pilot study.

core topic(s)

Early Literacy , Pediatric Primary Care

Population Characteristics

Kindergarten , Lingually Diverse , Poverty/Low-Income , Race, Ethnicity, and Culture

Exposures, Outcomes, Other

Clinic-Based Programs and Interventions , Implementation and Evaluation , Ready and Healthy for Kindergarten , School Readiness and Educational Outcomes , Validity, Reliability, Feasibility, and Acceptability


To describe the development and pilot testing of a bilingual family literacy program (FLP) for dual language learners entering kindergarten implemented in a Federally Qualified Health Center (FQHC).


Ready and Healthy for Kindergarten program.

outcomes evaluated

Program attendance and acceptability.


A FQHC in a Northeastern city in the US with a population of approximately 55,000 people. Most of the patients served at the FQHC identify as Hispanic/Latino (71%) and have incomes below 100% of the Federal Poverty Level (84%).


The Ready and Healthy for Kindergarten program is an English-Spanish bilingual FLP that uses four parent and pediatrician-prioritized health topics to introduce early English literacy skills to families and promote health behaviors that are important for school readiness while encouraging maintenance of Spanish. We developed an FLP manual, conducted a 16-week single-arm pilot study, and modified the FLP based on family feedback and observation.

sample size

n=14 (parent-child dyads)


Measure of Parent/Child Engagement: observational field notes.


Measures of Enrollment, Attendance, and Retention: the number of families that agreed to participate over approached and the number of families that completed the outcome assessment over those enrolled.


Measure of Parent Acceptability: the Acceptability of Intervention Measure (AIM) and the following two open-ended prompts:

    1. “Please tell us about your experience with the program”.
    2. “Please use 3 words to describe the program”.


We recruited 14 parent-child dyads for the pilot through clinician referral. All participating parents identified as Hispanic/Latino and 86% reported limited English proficiency. Two-thirds had less than a high school education. Seventy-one percent of families attended more than half of the sessions. Parents rated the FLP as highly acceptable. During implementation, we made substantive changes to the FLP including increasing the focus on promoting bilingualism, encouraging all participants to share their experiences with the health topics, helping parents identify literacy activities embedded in their daily health routines (e.g., lullabies), and distributing information on health resources.


We developed and implemented an innovative bilingual FLP in an FQHC that was well-attended and acceptable to families. The FLP has the potential to be replicated in other primary care sites and our findings lay the groundwork for future studies on how to best leverage healthcare settings to promote equity in school readiness.


First, because we implemented the FLP in one community, our findings may not generalize to all settings. Second, since a small sample of 14 families enrolled in the study, our results may be subject to selection bias. Third, given that this study was a time-limited pilot, we could not definitively test the effect of the intervention on parenting behavior and/or literacy development. Fourth, although we used a standard approach to translation, the AIM was not validated in Spanish. Fifth, we did not obtain feedback from the children enrolled in the study.