Background: Illiteracy is a major factor contributing to health disparities. Interventions need to begin early to promote literacy levels which allow individuals to read health materials. One intervention, Reach Out and Read begins in clinic between birth and six months of age. Previous research on Reach Out and Read, a clinic-based literacy program, has demonstrated an increase in parent-child literacy activities in the homes of low-income families as reported by parent surveys. The tool used to collect these data has not been tested with a middle or upper middle class sample.
Objective: To compare parent-child literacy activities in the home as measured by the Parent-Child Activities Survey between samples of low-income patients and middle-upper income patients.
Design/Methods: A convenience sample of children was recruited from a hospital-based practice serving primarily Medicaid-eligible children (Medicaid) and a private pediatric practice (Private) serving primarily children with private health insurance. Parents in both sites were interviewed in the waiting room using the Parent-Child Activities Survey. The survey asks open-ended questions about parent-child activities in the home, specific questions about books and reading, and demographic information. Summary measures are reported as mean(M) and standard deviation (SD). Significance was computed using the Chi-Square statistic.
Results: Data were collected during 2000 and 2001. The sample consisted of 83 children from birth to 5 years of age in the Private group (M=26 mo,SD=18.02) and 246 children from birth to 5 years of age in the Medicaid group (M=26 mo, SD=17.67). In response to open-ended questions about favorite shared activities and activities to prepare children for success in school, there were no significant differences in the proportion of parents who mentioned reading or books (Private vs. Medicaid: 51% vs 54%). However, parents in the private practice were significantly more likely to mention reading a book to prepare the child for sleep at night (54% vs 31%, p=.001). Parents in the Private group were also significantly older and more educated, and fathers were more likely to live in the home compared to the Medicaid group. Children in the Private group had more books for children in their homes.
Conclusions: In a series of three questions used to measure parent-child literacy activities we found a significant difference between the low-income families and the middle-upper income families on only one measure - reading at bedtime. Perhaps asking parents about their three favorite activities to do with their child does not elicit actual literacy activities in the home. A major question that emerges is: Should the currently accepted measures of parent-child literacy activities be re-examined?
Implications: Pre-literacy programs are being implemented in over 1100 clinics in the United States. They are being implemented in communities where great health disparities exist between poor children and middle class children. These disparities affect school readiness, life long learning and potential future earnings. If the efficacy of clinic pre-literacy programs is to be proven, appropriate measures must be developed that reflect changes resulting from anticipatory guidance provided by the nurses and primary care providers.
Back to Studies in Health Care Economics and Interventions
Back to The Advancing Nursing Practice Excellence: State of the Science