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

项目概要/摘要 来自低收入拉丁裔背景的儿童患发育迟缓的风险较高， 入学准备方面的持续差异。早期分享阅读可以提高语言和社交情感技能 获得，这对入学准备至关重要，但来自低收入，拉丁美洲背景的家庭较少 可能会参与这项活动。在过去30年里，通过鼓励在初级保健中开展扫盲工作， 共享阅读已经发展成为儿科护理标准。然而，目前的初级保健扫盲工作 这些努力依赖传统的办事处模式，与社区资源的联系和外联有限 这可以帮助解决幼儿发展中持续存在的差距。在前期工作中，我们 确定了一个意图行为差距作为一个关键的障碍;低收入的拉丁裔父母认为共享阅读 重要的是，打算阅读，但没有定期从事这项活动。作为回应，我们开发了 外展短信，以鼓励在诊所访问之外与关键合作共享阅读 包括家长在内的利益相关者。最初的试点表明， 除了标准扫盲宣传之外，还提供有关家庭扫盲环境的外展短信。我们发现 与贫穷有关的生活压力是短信无法解决的一个重要障碍。我们的初步 工作和理论表明，有必要进行推广，并将初级保健扫盲促进与贫困相结合， 减少可以促进儿童健康发展的努力。我们提议进行一项3组随机临床试验， 旨在提高低收入拉丁裔家庭识字率的测试策略。我们将招募630名 社区健康中心为低收入的拉丁裔家庭提供服务。父母会 随机分配到3个组中的一个组（1）"伸出手去阅读"（ROR），这是一项基于证据的扫盲促进活动 （2）ROR加上量身定制的外展短信;（3） 注重成果的报告加上量身定制的外联短信，并利用广泛的 简化获得服务和提供护理协调的传播模式。在目标1中，我们将测试 假设（1）ROR加短信组的儿童在验证的 与单独的标准ROR相比，对语言和社会情感发展的评估;（2） 同时收到短信和获得更多减贫资源的儿童， 与其他两个手臂相比。在目标2中，我们将研究 干预措施。在目标3中，我们将使用混合方法进行流程评估，以了解如何 实施干预措施，确定障碍、促进因素和适应措施，并探索父母的经验 进行干预。这一信息将有助于促进在国家一级传播所吸取的经验教训， 网络.我们希望成功完成这些目标将导致知识，可以改变如何 提供初级保健干预措施，以促进发展保健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.