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Evaluation of a clinic-based program to promote book sharing and bedtime routines among low-income urban families with young children.

OBJECTIVE
To evaluate a program of anticipatory guidance in which pediatric residents and nurse practitioners in a continuity practice gave parents books for their young children along with developmentally appropriate educational materials describing why and how to share the books and promoting reading as part of a bedtime routine.


STUDY DESIGN
Comparison of 2 cross-sectional groups using consecutive, structured, face-to-face or telephone interviews of parents. One group was a historical control or a comparison group (group 1). The other was the intervention group (group 2), which included families who had received 2 books and educational materials for the children as part of the program to promote book sharing and bedtime routines.


SUBJECTS
Before the institution of the program to promote book sharing and bedtime routines, the parents in 51 families with healthy children 12 to 38 months of age who regularly attended continuity clinics conducted by the house staff were interviewed; these families constituted group 1. Group 1 included a low-income population of Hispanic, African American, and non-Hispanic white families. Group 2 included 100 families with similar sociodemographic characteristics with healthy 12- to 38-month-old children who had received 2 books and educational materials at all 6- to 36-month well-child visits as part of the program.


RESULTS
The intervention was found to be effective in promoting child-centered literacy activities. When asked openended questions, 4 (8%) of the parents in group 1 and 21 (21%) of the parents in group 2 said 1 of their child's 3 favorite activities included books (P=.04); 11 (22%) of the parents in group 1 and 42 (42%) of the parents in group 2 said 1 of their 3 favorite activities with their child was book sharing (P=.01); and 10 (20%) of the parents in group 1 and 35 (35%) of the parents in group 2 said that they share books 6 or 7 times a week at bedtime (P =.05). By mentioning 1 of these 3 important child-centered book-sharing activities, 17 (33%) of the parents in group 1 and 69 (69%) of the parents in group 2 (P <.001) demonstrated positive child-centered literacy orientation . A multiple logistic regression analysis controlling for parental education, ethnicity, and reading habits, as well as for the sex and age of the children, found child-centered literacy orientation more likely to be present in group 2 than in group 1 families, with an odds ratio (OR) of 4.7 (95% confidence interval [CI], 2.1-10.5; P<.001). Book sharing as part of a bedtime routine was more frequent in group 2 (mean+/-SD, 3.9+/-2.6 nights per week) than in group 1 (mean+/-SD, 2.5+/-2.7 nights per week; P=.002); however, no significant differences in prolonged bedtime struggles, parent-child co-sleeping, frequent night waking, or how children fell asleep were found between the groups. Instead, in multivariate analysis, bedtime struggles occurred more often with younger parents (P=.03) and fewer children at home (P=.02), while parent-child co-sleeping (P<.001) and frequent night waking (P=.04) were less likely to occur when children usually fell asleep alone in their own beds.


CONCLUSIONS
This simple and inexpensive intervention by pediatric house staff, consisting of the provision of children's books and educational materials at well-child visits, resulted in increased enjoyment of and participation in child-centered book-related activities in low-income families. Primary care providers (ie, physicians and nurse practitioners) serving underserved pediatric populations may have a unique opportunity to promote child-centered literacy in at-risk groups.