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Text Messages to Improve Early Literacy in Children Who Live in Low-Income Settings

September 22, 2021

Although we know that school readiness is a predictor for later success, both in school and in life, there continue to be disparities in school readiness.

Reach Out and Read and other programs that advocate for early childhood literacy provide us with free books that we can give to our young patients, but I am often at a loss for additional supports that we might provide parents.

I was therefore excited to read “A Text-based Intervention to Promote Literacy: a Randomized Controlled Trial,” which is authored by Dr. Lisa Chamberlain and colleagues at Stanford University and Oregon Health and Sciences University and is being early released by Pediatrics this week (10.1542/peds.2020-049648).

The authors tested a text messaging program called TipsByText, in which parents of 3- and 4-year-olds received text messages three times weekly for 7 months. All families were recruited at 2 public pediatric clinics, which largely serve families with low income.

A total of 644 English- and Spanish-speaking families with low income were recruited; 263 were excluded because the children were already enrolled in school, leaving 381 families in the trial. Each week, the parents in the intervention group received texts with facts, tips, and encouragement – all to support literacy promotion in their children. The control group did not receive any text messages. Literacy screening tests conducted before and after the intervention showed that children in the intervention group demonstrated an increase in literacy scores, equating to approximately 3 months of literacy gains!

That is definitely encouraging news – that something as simple as this could help children who have traditionally had fewer opportunities to improve their school readiness. But is it this simple? We asked Dr. Jack Shonkoff and Dr. Dana Charles McCoy from Harvard to write a commentary (10.1542/peds.2021-052326), and of course, it’s not so simple. This intervention was more effective in older and first-born children, and it is unclear why this would be. We also don’t know why TipsByText works – does it encourage reading, parent-child interactions, or something else?

Please read both the article and the commentary. There is a lot of detail in both that are important to consider as we think about using mobile health strategies such as TipsByText to improve health outcomes in our patients.

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