Addressing Disparities in Language and Social-emotional Skill Acquisition through Literacy Promotion in Primary Care

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PROJECT SUMMARY/ABSTRACT Children from low-income Latino backgrounds are at elevated risk for developmental delays that contribute to persistent disparities in school readiness. Early shared reading improves language and social-emotional skill acquisition, which are critical for school readiness, but families from low-income, Latino backgrounds are less likely to engage in this activity. Over the past 30 years, literacy promotion in primary care by encouraging shared reading has evolved into a pediatric standard of care. However, current primary care literacy promotion efforts rely on traditional office-based models with limited outreach and linkage to community-based resources that can help address persistent disparities in early childhood development. In our preliminary work, we identified an intention to behavior gap as a key barrier; low-income Latino parents considered shared reading to be important and intended to read but did not engage in this activity regularly. In response we developed outreach text messages to encourage shared reading beyond the clinic visit in collaboration with key stakeholders including parents. An initial pilot demonstrated feasibility and a positive but partial effect of outreach text messages on the home literacy environment beyond standard literacy promotion. We found that poverty-related life stressors were an important barrier that text messages could not address. Our preliminary work and theory suggest the need for outreach and integrating primary care literacy promotion with poverty- reducing efforts that can promote healthy child development. We propose a 3 arm randomized clinical trial to test strategies designed to enhance literacy promotion for low-income Latino families. We will recruit 630 parent-child dyads from community health centers that serve low-income, Latino families. Parents will be randomly assigned to one of 3 arms (1) Reach Out and Read (ROR) an evidence-based literacy promotion intervention that is widely disseminated in primary care; (2) ROR plus tailored outreach text messages; (3) ROR plus tailored outreach text messages and enhanced access to poverty-reducing resources using a widely disseminated model that simplifies access and provides care coordination. In Aim 1, we will test our hypotheses that (1) children in the ROR plus text message arm will have higher scores on validated assessments of language and social-emotional development compared to standard ROR alone and (2) children who receive both text messages and enhanced access to poverty-reducing resources will have higher scores compared to the other two arms. In Aim 2, we will examine mechanisms that underlie the effects of the interventions. In Aim 3, we will use mixed methods to conduct a process evaluation to understand how the interventions are implemented, identify barriers, facilitators, and adaptations, and explore parents’ experiences with the interventions. This information will help facilitate dissemination of lessons learned across national networks. We expect successful completion of these aims will result in knowledge that can change how primary care interventions are delivered to promote equity in developmental health and school readiness.