Pediatric Literacy Promotion for Latino Families by Texts and Referrals: A 3-Arm RCT

OBJECTIVE To test 2 strategies designed to enhance primary care–based literacy promotion (LP): (1) text message reminders (texts), and (2) texts plus referral to community resources. METHODS We recruited 630 Latino caregiver-infant (aged 6 to 12 months) dyads for an effectiveness-implementation hybrid type 1 randomized trial. Dyads were randomly assigned into (1) LP-only (Reach Out and Read), (2) LP plus text messages (LP+texts), or (3) LP+texts plus referral to Connecting New Jersey (CNJ) (LP+texts+CNJ), which streamlines access to community resources based on the national Help Me Grow model. Participants completed online surveys and assessments at enrollment, and 9 and 18 months after enrollment. Primary outcomes focused on 3 domains: child language and social-emotional development, and parenting behaviors, including reading and verbal responsiveness. We followed the intent-to-treat principle and used step-down minimum P value method to adjust for multiple comparisons. RESULTS Among caregivers, 74% had less than or equal to a high school diploma and 88% reported speaking English less than very well. At 18 months after enrollment, the LP+text arm [effect size (ES) = 0.391; adjusted (adj.) P = .001] but not LP+text+CNJ had higher language scores compared with LP-only. At 9 and 18 months after enrollment, the LP plus texts plus CNJ arm had higher scores on social-emotional development than LP-only (ES = 0.267; adj. P = .04 and ES = 0.300; adj. P = .03, respectively), whereas the LP+text arm did not. At 9 months after enrollment, scores were higher for the LP+text+CNJ arm on verbal responsiveness (ES = 0.400; adj. P  CONCLUSION Two strategies with high potential for scale enhanced LP’s ability to promote relational and developmental health. Clinicians and policymakers can use this knowledge to optimize LP’s impact.