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QUESTION: Among low income Hispanic families with young children, does a literacy promotion intervention delivered by paediatric primary care providers increase parent to child reading?
Design
Quasi-randomised {allocation not concealed*,†}, blinded (outcome assessor)*, controlled trial with a mean follow up of 10 months.
Setting
2 paediatric healthcare centres in Providence, Rhode Island, USA.
Participants
135 families who were Hispanic or spoke Spanish at home with an infant between 5 and 11 months of age. Exclusion criteria were birth weight <2200 g, developmental delay, medical problems, or the accompanying adult was not the primary caregiver of the child. 130 families were included in the analysis. The children were a mean age of 7.4 months at baseline and 17.7 months at follow up.
Intervention
Families were allocated to a literacy promotion intervention (n=65) or a control group (n=70). At enrolment and at 2 consecutive well child visits, families in the intervention group received a bilingual handout explaining the benefits of reading aloud to children, literacy related guidance from paediatric providers, and an age appropriate bilingual children's board book (4 books were selected for the 6, 9, 12, and 15 month visits). Control group families received no books or handouts.
Main outcome measures
Frequency of parents reading to children, parental enjoyment of reading to children, and the number of children's books in the home were obtained in a follow up interview. A modified version of the MacArthur Communicative Development Inventories was also given to obtain a receptive and expressive language score.
Main results
The literacy promotion intervention increased the frequency of parent to child reading (p<0.001), more intervention group parents reported that reading to their children was one of their 3 favourite activities (p<0.001), and more intervention group parents reported having ≥5 children's books at home (p<0.001) (table)⇓ Children's overall early oral language skills did not differ between the 2 groups.
Literacy promotion intervention v control at a mean follow up of 10 months in low income Hispanic families‡
Conclusion
Among low income Hispanic families with young children, a literacy promotion intervention delivered by paediatric primary care providers increased parent to child reading, parental enjoyment of reading to children, and the number of children's books in the home.
Commentary
This interesting study by Golova et al raises issues about the best way to intervene for infants and children at high risk of language delay. Reading failure and language delay are among the factors associated with school failure, general developmental problems, and emotional and behavioural problems. Retrospective studies suggest that promoting reading in the home improves language and school performance. The acquisition of language seems, however, to be more complex than such studies suggest and is also promoted by positive parent-child relationships and the overall quality of the child's socioemotional environment.1
This report highlights the fact that primary care settings provide an important opportunity for simple, yet potentially effective, preventive interventions in infancy and early childhood. It also shows that preventive strategies are effective in higher risk groups, in this case socially disadvantaged parents from an ethnic minority group. What is less clear from this study is the potential benefit of increasing parent-child reading because the authors were not able to show improved overall language development in the intervention group.
Improvement of parent-child interaction and positive relationship functioning may be an important factor in promoting socioemotional and cognitive development. It would seem important that language development not be looked at in isolation but be seen as part of overall development across many domains. Fonagy's recent review of prevention and early intervention studies in early childhood concludes that successful programmes have multiple components which focus on a range of risk factors and tend to be of more than one year's duration.2 The quality of parenting and attachment are also important underlying variables that promote development. The improved parent-child relationships reported by reading parents may well be worth further evaluation.
References
Footnotes
Sources of funding: 1996-1997 Special Projects Research Fund of the Ambulatory Pediatric Association and Brown University.
For correspondence: Dr N Golova, Division of Ambulatory Pediatrics, Rhode Island Hospital, POB Suite 230, 593 Eddy Street, Providence, RI 02903, USA. Fax +1 401 444 7574.
↵† †Information supplied by author.