Research Spotlight: Parent-led design of early relational health messaging for pediatric primary care
Communicating, learning, and even playing has evolved in the wake of the pandemic, altering how parents navigate rules and recommendations around parenting in an increasingly digital age. While the power of Early Relational Health is well understood, it remains a force we’re just learning to quantify or discuss adequately with families. In her work with families and as a primary care provider, Danielle Erkoboni, MD, Director of the Literacy Lab (Lit Lab) at the Children’s Hospital of Philadelphia (CHOP) understood how these barriers both limit a provider’s integration of Early Relational Health messaging into anticipatory guidance and affect how families perceive the guidance provided. In 2023, Lit Lab received support from the William Penn Foundation to develop messaging around the power of relational health and healthy screen media exposure alongside parents.
For this study, Lit Lab enrolled 25 families of children from birth to age 5 to a Family Advisory Board. Each family participated in an ethnographic interview and in-home observation session, painting a shared picture of the lived experiences of families, with a focus on family relationships, supports around early learning, and the effect of screen media use. Interview and observation data were coded using grounded theory to identify themes used to establish content for our next round of design.
Next, in a series of design workshops, families refined and narrowed the emergent themes, which included: establishing a balanced routine, embracing parenting as a journey, maintaining a sense of self, maximizing free and affordable resources, balancing parenting influences on children’s emotional responses, managing screen time, seeking out support systems, and combating feelings of inadequacy from social media. Through continued design thinking sessions, the family advisory board is currently refining these draft messages into content — parent voiced phrasing, visual images and concepts that can be employed in relational health training sessions for pediatric primary care providers. In the next phases of this work, families will train providers, taking these messages directly to our medical offices to support the integration of Early Relational Health anticipatory guidance through Reach Out and Read.
Reach Out and Read sponsors research awards administered through the Academic Pediatric Association
From 2011-2023, we sponsored awards through the Young Investigator Award program. In 2024, in response to feedback from our researchers, we launched the Collaborative Research Awards Program. This award engages a collaborative team to advance early relational health and early childhood development through primary care-based early literacy interventions, including Reach Out and Read and other related programs and their extensions to the community. The study team will represent diversity in lived experience and academic institution, including an early career investigator-mentor team.
Announcing the first award of the Collaborative Research Awards Program
We are delighted to announce the award of the 2024 Collaborative Research Award to Yu Chen and Caitlin Canfield from New York University Grossman School of Medicine, Milton Guendica, Adriana Weisleder,and Mariana Glusman from Northwestern University and Anna Miller-Fitzwater from Wake Forest University School of Medicine to work on the project “Enhancing Early Relational Health through Promotion of Home Language: Utilizing Parent and Pediatrician Voices to Adapt Reach Out and Read.”
Project Summary
Many children in the United States hear a language other than English at home, a majority of whom are from Spanish- and Chinese-speaking backgrounds. Children from these homes tend to shift to English dominance early in life, resulting in a mismatch between parent and child language use, which in turn is associated with less effective parent-child communication and less positive parent-child relationships.
Primary care interventions like Reach Out and Read (ROR) are an effective approach for enhancing early relational health and parents’ language and literacy practices at home. However, the current ROR model is not focused on providing guidance for pediatricians on bilingual development and home language maintenance to meet the needs of bilingual and language minority (BiLM) families—a population disproportionately affected by health inequities. To support effective program delivery to BiLM families, our project aims to expand and broaden ROR by centering parent and pediatrician voices with the goal of promoting early relational health in these families. To do so, this APA CRA study will: 1) assess pediatricians’ knowledge and practices about early literacy promotion with BiLM families; 2) identify Spanish- and Chinese-speaking parents’ challenges and needs in raising bilingual children; and 3) develop a cultural and linguistic adaptation of ROR with specific applications to Spanish- and Chinese-speaking families. This study is a first step in strengthening the ROR model to best serve BiLM families in home language maintenance and early relational health.