Early Literacy Research Library (ELRL) - Article

Shifting Parental Beliefs About Child Development to Foster Parental Investments and Improve School Readiness Outcomes

Leung, C.Y.Y., Trinidad, J.E., Suskind, D.L. (2022) Video-Based Anticipatory Guidance on Early Cognitive and Language Development in the First 6 Months: A Randomized Controlled Trial. The Journal of Pediatrics, 245, 227-229. ,

Access: Institutional Access

Publication year


study description

Randomized controlled trial.

core topic(s)

Early Literacy

Population Characteristics

Infant/Newborn , Poverty/Low-Income , Urban

Exposures, Outcomes, Other

Anticipatory Guidance , Brain/Neurocognitive , Child Development (general) , Clinic-Based Programs and Interventions , Language and Literacy Development , Parent Behaviors and Skills , Parent Knowledge, Attitudes, and Beliefs , Parent-Provider Relationships/Interactions , Technology and Digital/Screen-Based Media


We examined whether the video-based anticipatory guidance would increase knowledge of early cognitive and language development, which in turn promote cognitive growth fostering behaviors among parents of low-SES.


Video-based anticipatory guidance.

outcomes evaluated

Knowledge of early cognitive/language development and cognitive growth fostering behaviors.


10 pediatric clinics predominantly serving families of low-SES in Chicago.


Parent-infant dyads were randomized by the lead research assistant into either the intervention (video-based anticipa-tory guidance on early cognitive and language development) or control (sudden infant death syndrome video or usual-care) condition, using block randomization method... Using a tablet provided by a research assistant, parents in the intervention condition watched 1 video-based anticipatory guidance module at the 1-month, 2-month, 4-month, and 6-month well-child visits.

sample size

n=340 (dyads, total); n=168 (dyads, intervention); n=172 (dyads, control)


Measure of Parental Knowledge about the Role of Caregiver Responsiveness and Inputs in Early Childhood Cognitive/Language Development: Survey of Parent/Provider Expectations and Knowledge (SPEAK) administered at 1-week and 6-month visits.


Measure of Parent Cognitive Growth Fostering Behaviors: 5-minute teaching task with their infant at the 9-month visit, by certified research assistants who obtained the required 90% interrater reliability, using the revised Nursing Child Assessment Satellite Training8 Teaching Scale.


Sociodemographic characteristics and parental knowledge at baseline were not significantly different across the 2 conditions (baseline demographics are described in the Table; available at www.jpeds.com). Preliminary correlation analysis revealed that parental employment status (employed vs unemployed) and primary language (English vs non-English) were significantly correlated with parental cognitive growth fostering behaviors (r = .13, P < .05 and r = .24, P < .001, respectively). These 2 variables were, therefore, examined as covariates in the mediation model. Parental knowledge fully mediated the intervention impact on parental cognitive growth fostering behaviors (total effect c: b = 0.22, P < .05; direct effect c’: b = 0.12, P > .05) (Figure 2). Parents who received the intervention had more knowledge at 6 months (a: b = 0.67, P < .001). More knowledge at 6 months in turn predicted more cognitive growth fostering behaviors at 9 months (b: b = 0.15, P < .01). The indirect effect of the intervention on behaviors through knowledge was significant (ab: b = 0.10, P < .01, 95% CI 0.09-0.57). Results indicated that the video-based anticipatory guidance on early cognitive and language development significantly enhanced parental knowledge, which in turn promoted their cognitive growth fostering behaviors.


This randomized controlled trial showed that video-based anticipatory guidance implemented at well-child visits in the first 6 months increased knowledge of early cognitive and language development (P < .001), which in turn promoted cognitive growth fostering behaviors among parents of low socioeconomic status (95% CI 0.09-0.57).


The video-based anticipatory guidance intervention was implemented using a one-size-fits-all approach without considering the heterogeneity among parents.2,10 Moreover, parental cognitive growth fostering behaviors were assessed based on a 5-minute teaching task during a well-child visit without examining whether the intervention would promote parents’ positive caregiving behaviors in their natural home environments.