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

项目摘要/摘要 来自低收入拉丁裔背景的儿童患发育迟缓的风险增加，这可能导致 在就学准备方面持续存在差异。早期共享阅读可提高语言和社交情感技能 收购，这对入学准备至关重要，但来自低收入、拉丁裔背景的家庭较少 有可能从事这项活动。在过去的30年里，通过鼓励在初级保健中促进识字 共享阅读已经演变成一种儿科护理标准。然而，目前初级保健扫盲的促进 这些努力依赖于传统的办公室模式，与社区资源的联系有限。 这有助于解决儿童早期发展中长期存在的差距。在前期工作中，我们 认为意向与行为差异是一个关键障碍；低收入的拉丁裔父母认为共享阅读 很重要，打算阅读，但没有定期参加这项活动。作为回应，我们开发了 与Key合作，在诊所就诊之外鼓励共享阅读的推广短信 利益相关者，包括父母。最初的试点证明了可行性和积极但部分的效果。 关于标准识字推广之外的家庭识字环境的外展短信。我们发现 与贫困相关的生活压力源是短信无法解决的重要障碍。我们的预赛 工作和理论表明，有必要扩大宣传范围，并将促进初级保健扫盲与贫困结合起来-- 减少能够促进儿童健康发展的努力。我们建议进行3组随机临床试验，以 测试旨在提高低收入拉丁裔家庭识字率的战略。我们将招募630人 来自为低收入拉丁裔家庭服务的社区卫生中心的亲子二人组。家长们会是 随机分配到3个手臂中的一个(1)接触并阅读(RoR)基于证据的扫盲促进 在初级保健中广泛传播的干预措施；(2)ROR加上量身定制的外展短信；(3) RoR加上量身定做的外展短信，并利用广泛的 传播的模式，简化了通道并提供护理协调。在目标1中，我们将测试我们的 假设(1)ROR加短信组的儿童在验证上有更高的得分 对语言和社会情绪发展的评估与标准的ROR比较(2) 同时收到短信和更好地获得扶贫资源的儿童将拥有更高的 与其他两只手臂相比得分更高。在目标2中，我们将检查作为基础的机制 干预措施。在目标3中，我们将使用混合方法进行过程评估，以了解 实施干预措施，确定障碍、促进者和适应，并探索父母的经历 与干预措施有关。这些信息将有助于在全国范围内传播吸取的经验教训。 网络。我们希望这些目标的成功实现将带来知识，从而改变 提供初级保健干预措施，以促进发展健康和入学准备方面的公平。

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.