Early Literacy Research Library (ELRL) - Article

Understanding Barriers to Literacy Promotion Among New Jersey General Pediatricians

Mayne, J., Pai, S., Morrow, L., Lima, D., Jimenez, M.E. (2018) Understanding Barriers to Literacy Promotion Among New Jersey General Pediatricians. Clinical Pediatrics, 57(6), 667-671. ,

Access: Institutional Access

Publication year


core topic(s)

Early Literacy

Population Characteristics

Medical Providers

Exposures, Outcomes, Other

Child Development (general) , Disparity/Adversity , Medical Training/Education , Provider Behaviors and Skills , Provider Knowledge, Attitudes, and Beliefs


Low literacy is associated with poor health. We sought to examine pediatricians' attitudes and practices regarding literacy promotion in early childhood.

outcomes evaluated

Early literacy promotion attitudes, knowledge, behaviors, and barriers.


New Jersey primary care pediatricians.


We distributed a self-administered 23-item survey to a random sample of 500 board certified or eligible New Jersey primary care pediatricians. 134 surveys were returned, 25 of which were excluded.

sample size

n=134 (total surveys); n=25 (surveys excluded (n=25); n=109 (surveys included)


Measure of Literacy Promotion Attitudes, Knowledge, and Practice: 23Q self administered survey based on literature review, expert consultation, and pilot study using a 6-point ordinal scale assessing the degree they agree/disagree to questions and open-ended responses to barriers of implementation:

    • Attitudes: perception of his or her role in literacy promotion and the perceived benefit of a literacy program in the pediatric office.
    • Literacy Training/Knowledge: residency training experience, exposure to ROR, perceived awareness of skills to enhance literacy, and the knowledge of community resources to connect patients.
    • Current practice/behaviors: respondent’s referral to community resources and reading activities in the office.


In all, 91% of pediatricians in our sample agreed that literacy promotion was an essential aspect of practice, and two-thirds agreed that they conduct activities to promote literacy. A total of 77% of pediatricians who completed their training ≤20 years ago agreed that they were adequately trained to promote literacy compared with 58% who completed their training >20 years ago ( P = .04). Physicians reported several barriers including time constraints and insufficient funding.


While most pediatricians in our sample reported that literacy promotion is important, they less actively address the topic during well-child visits. Further study is needed to facilitate successful implementation of existing literacy promotion guidelines.


First, although we implemented several procedures to optimize survey completion, we had a relatively low survey response rate for a physician survey.18 For example, we included self-addressed, stamped envelopes with the survey and study documents, with sequential reminder surveys. We also accounted for the length of surveys and the time to completion of the survey in creating the questions, so as to ease the completion of the survey. Despite these procedures, given our relatively low response rate, our findings may be subject to nonresponse bias. Second, given that this is a survey and we did not confirm literacy promoting activities, our findings may also be subject to social desirability bias. Third, given that our respondents are all practicing pediatricians in New Jersey our findings may not generalize to all settings. Despite these limitations, we generated information regarding current literacy promotion practices of pediatricians and barriers to implementing these efforts that can inform efforts to implement literacy promotion guidelines.