Promoting Early Literacy Using Digital Devices: A Pilot Randomized Controlled Trial.

OBJECTIVE: To determine feasibility and explore effects of literacy promotion using e-books versus board books on the home reading environment, book reading, television use, and child development. METHODS: Randomized controlled trial comparing digital literacy promotion (DLP) using e-books to standard literacy promotion (SLP) using board books among Medicaid-eligible infants. DLP participants received e-books on home digital devices, while SLP participants received board books at well visits between 6 and 12 months of age. Differences in StimQ Read Subscale (StimQ-Read) scores, parent-reported reading and television use, and Bayley Scales of Infant Development-3rd Edition (Bayley-3) scores between groups were assessed using intention-to-treat analysis. RESULTS: A total of 104 Medicaid-eligible infants were enrolled and randomized from 3 pediatric practices. There were no differences in sociodemographic characteristics between groups at baseline. Children in the DLP group initially had lower StimQ-Read scores but showed similar increases in StimQ-Read scores over time as children in the SLP group. Parents in the DLP group reported greater use of digital devices to read or engage their child (65% vs 23%, P < .001) but similar board book reading and television viewing. There were no differences between groups in cognitive or motor scale scores, but DLP participants had marginally lower language scales scores (DLP 85.7 vs SLP 89.7; P = .10) at the 6-month follow-up. CONCLUSIONS/DISCUSSION: Literacy promotion using e-books was feasible and associated with greater e-book usage but no difference in board book reading, television viewing, or home reading environment scores. A potential adverse impact of e-books on language development should be confirmed in future study.

Effects of Early Literacy Promotion on Child Language Development and Home Reading Environment: A Randomized Controlled Trial.

Objective: To determine if early literacy promotion, which consisted of board books and reading promotion beginning with newborns, is more effective than standard literacy promotion beginning at 6 months. Study design: Hybrid type 1 randomized controlled implementation trial of Medicaid-eligible newborns. Prior to 6 months of age, early literacy promotion participants received board books and reading promotion at well visits plus weekly text messages on reading, while standard literacy promotion participants only received weekly text messages on safety. Both groups received board books and reading promotion at well visits after 6 months as part of Reach Out and Read. Measures included proportion who received board books to assess implementation and StimQ Read Subscale (SQRS) scores and Preschool Language Scale-Fifth Edition (PLS-5) scores at 6 and 24 months to assess outcomes. Differences in measures were assessed using intention-to-treat analysis. Results: Of 120 newborns enrolled, most were African American, resided with a single parent, or had a parent with ≤high school education. Overall 82% of early literacy promotion participants received books/counseling at well visits <6 months old. Children in the early literacy promotion arm had greater SQRS scores (11.0 vs 9.4, P = .006) but similar PLS-5 scores at 6 months, but there were no differences in SQRS or PLS-5 scores between groups at 24 months. Conclusions: Implementation of a literacy promotion program early in infancy was associated with richer home reading environments at 6 months but did not improve language development. Although an early literacy program was feasible, additional study may be needed to assess other potential benefits. Trial registration: Clinicaltrials.gov: NCT02713659.

Number of children's books in the home: an indicator of parent health literacy.

BACKGROUND: One in 4 US adults have poor health literacy, unable to read and understand written medical information. Current tools that assess health literacy skills are too lengthy to be useful in routine clinical encounters. OBJECTIVE: To determine which of 7 screening questions is most useful for identifying parents with adequate health literacy. DESIGN/METHODS: A cross-sectional study of an ethnically diverse sample of 163 parents of children aged 12 to 24 months presenting for routine care at 1 of 6 inner-city clinics. Literacy was measured by performance on the Short Test of Functional Health Literacy for Adults, which was categorized as "adequate" or "inadequate or marginal." The 7 screening questions concerned parents' educational achievement, educational expectations for the child, and home literacy environment. RESULTS: Eighty-three percent of respondents had adequate health literacy, which was highest among those who were African American, were born outside the United States, spoke English primarily at home, and had completed high school. Only 2 factors, however, were independently associated with adequate health literacy: more than 10 adults' books or more than 10 children's books in the home. "More than 10 children's books" had a positive predictive value of 91%. CONCLUSIONS: Having more than 10 children's books in the home is a useful, independent indicator of adequate parent health literacy. More research is needed, however, to find a better screening tool for identifying parents with increased health literacy needs.

Screening for low literacy among adult caregivers of pediatric patients.

BACKGROUND AND OBJECTIVES: The association between functional illiteracy and poor health has led to pediatric literacy promotion programs in the primary care setting. These interventions do not address linked parental literacy needs. An obstacle to referring adults to literacy services is the lack of an instrument that can efficiently identify individuals who could benefit from such programs. We sought to identify screening items sufficiently simple to use in clinical practice. METHODS: This cross-sectional study examined 98 adult primary caregivers of preschool children seen in an inner-city primary care setting. Literacy level and 17 variables predicted to be associated with low literacy were assessed. RESULTS: Three items were independently associated with a 6th grade reading level: (1) less than 12th grade completion, (2) not living with the child's other parent, and (3) not reading for pleasure. Receiver operating characteristic (ROC) curve analysis indicates that, used together, these variables have discriminant capacity, with an area under the ROC curve of.76. CONCLUSIONS: Three items for use in a simple screening instrument for parental low literacy were identified. Used together, they had favorable characteristics but must be further tested for generalizability.