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Promoting Early Child Development and School Readiness through Support for Parent-Child Reading Aloud in Brazil

Thu, March 21, 4:00 to 5:30pm, Hilton Baltimore, Floor: Level 2, Key 9

Integrative Statement

There is increasing recognition of the need for low cost, population-scalable public health interventions to prevent poverty-related disparities in early child development and school readiness (Shonkoff et al., 2012). In the US, pediatric primary has emerged as a platform for universal engagement to meet this need, and pediatric programs have sought to prevent disparities by enhancing early cognitive stimulation (e.g., shared reading) in the home (Cates, Weisleder, & Mendelsohn, 2016). The largest-scaled program is Reach Out and Read (ROR), which provides books, modeling and guidance(Klass, Dreyer, & Mendelsohn, 2009). Video Interaction Project (VIP) was developed as an enhancement to ROR, adding an interventionist who video-records parent-child reading aloud and play, and reviews the tape to support self-efficacy and skill development(Mendelsohn et al., 2005). Extensive research of ROR and VIP has documented impacts on parent-child and child outcomes(Cates et al., 2016).

These programs are potentially important for low and middle income countries (LMIC), in which cognitive stimulation during early childhood has been identified as important for school readiness, yet only 10-41% of children have access to cognitively stimulating materials, and only 11-33% of parents engage in activities such as reading aloud at home(Walker et al., 2011). However, implementation and study of such programs in LIMC have been more limited (Engle et al., 2011). Barriers include lack of population-scalable platforms and costs of provision of learning materials such as books and toys. Furthermore, an important and unanswered question is whether promotion of cognitive stimulation, including reading aloud, would be as effective in the context of poverty-associated factors more common in LIMC such as low parental literacy.

This paper will describe study of a program (“Universidade de Bebê”, UBB/Instituto Alfa e Beto) seeking to enhance parent-child interactions and child development in Boa Vista in northern Brazil, and utilizing early childcare centers as a population-level platform. UBB was developed as part of a mayor-led initiative seeking to integrate health, education, and social services for low income families, and included adaptation of elements of ROR and VIP. There were two components: 1) a book-lending library, allowing parents to borrow children’s books to take home on a weekly basis, and 2) monthly parent workshops with a facilitator who guides discussion related to reading aloud and other opportunities for interacting with children.

We performed a cluster randomized controlled trial of the program comparing families in 22 childcare centers with and without addition of the parenting program. Half of the centers (n=11) were randomized to receive the parent program; the other half did not receive it. Assessments of family sociodemographics, parenting, and child development (including parent interviews and direct child assessments) were performed at enrollment at the beginning (child age: 2-3 yrs) and end (3-4 yrs) of the school year, with 464 dyads contributing data at follow up. This presentation will consider how family-level factors such as maternal literacy moderate impacts on parent-child interaction and child development(Weisleder et al., 2018). Understanding these factors will have considerable implications for refinement, implementation and scaling of such programs in LIMC.

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