Newborn literacy program effective in increasing maternal engagement in literacy activities: an observational cohort study

Reading is an important component of literacy but does not begin until just prior to or after school entry. The foundational skills that precede reading are developed before entering elementary school [1] and parents can play a pivotal role in developing these skills with their children. Children who experience difficulty with reading and literacy early on often will continue to suffer from low literacy and have problems that persist into the school years [2].

Several studies have found a positive relation between storybook exposure and vocabulary in kindergarten [3‐5]. Frequency of storybook reading is not the only important factor in the development of literacy skills in young children, but it can influence vocabulary and other language and reading behaviours. This relationship has primarily been explored in toddlers and children in early elementary school. There has been limited exploration of this in children from birth through infancy. The finding that maternal attitudes toward shared reading in infancy and resources (e.g. number of baby books in the home) are predictors of parental engagement and reading behaviours at age 6 months [6] points to the need to evaluate ways of positively influencing these behaviours in mothers and families from birth. This can include anticipatory guidance such as education as to the benefits of early reading and/or book-gift programs.

Many early literacy intervention programs exist including Reach Out and Read in the United States, Bookstart in the United Kingdom and Read to Me! in Nova Scotia, Canada. The Read to Me! program gives a gift of books and other literacy materials to parents at the hospital bedside prior to leaving hospital after the birth of a baby.

The purpose of the current study is to examine the effectiveness of the Read to Me! program in Nova Scotia (NS) on the frequency with which mothers engage in literacy activities with their infants compared to mothers of newborns in Prince Edward Island (PEI) who did not receive a literacy intervention. It was hypothesized that mothers who receive the Read to Me! program will engage in reading and other active literacy based activities, such as singing and talking, with their newborn more often and for longer periods of time than those mothers who received no intervention. Engagement in passive activities such as watching TV, listening to CDs and listening to the radio were also compared between groups.

In this study mothers who received the Read to Me! literacy package in the hospital when their baby was born read more to their babies compared to mothers who did not receive it. These findings provide evidence that Read to Me! is an effective intervention to increase the amount babies are read to. We believe that the 5 minute increase in reading time is clinically relevant because it represents a substantial increase in the intervention group as compared to the control group. The control group read 12 minutes a day and a 5 minute increase therefore is a 40% increase. Studies have shown that the earlier children are read to the greater the effect on later language skills. If interventions, such as Read to Me! can significantly increase time spent reading then this may have a meaningful impact on later literacy skills. We had not a priori defined what amount of improvement in reading time would be clinically meaningful but are confident that the results support the benefit of the Read to Me! program.

Previous studies have shown that the earlier children start to be read to, the greater the effect on language skills [7, 8]. Our result, in the context of such studies, may be clinically meaningful as it suggests that interventions which substantially increase engagement in literacy activities with children starting at birth may positively affect later language and literacy skills.

It was originally intended that infants older than 10 months were to be included but we were unable to contact many infants greater than 10 months so they were excluded. The lower range started from birth as there are few studies that exist which focus on literacy activities in this age group and we felt it was important to examine this further.

It is well established that the foundations for literacy begin well before children are able to read. There is evidence that the development of literacy skills begins at birth, continues through schooling and is related to later academic success [9]. Children’s early experiences including exposure to books, early language and literacy skills, are important contributors to reading ability in grade school. [10].

Using a cumulative risk model Cadima et al. [11] found that both preschool and first grade literacy skills were influenced by family risk factors such as number of parents in the home, income and maternal education. This highlights the importance of creating literacy interventions which target children before they reach preschool. Many studies have been conducted which look at reading and its precursors but few have focused on interventions targeted at infants.

Book-gift programs, such as Reach Out and Read! in the United States, have been well studied and have proven to be effective interventions for encouraging shared reading in the home for preschool-aged children [12‐15] but evidence for children under 1 year is lacking.

The attitudes of mothers with regards to shared reading and resources available to them (i.e. number of baby books in the home) at the birth of their baby are both predictors of shared reading at 6 months [6]. This would suggest that providing additional resources to mothers at the birth of their baby, such as with a package similar to Read to Me!, may influence their attitudes and in turn may encourage engagement in shared reading beginning in early infancy. The present study has shown this simple intervention to be an effective means of increasing shared reading between mothers and their newborns. By providing age-appropriate baby books as well as other resources to parents while in the hospital, Read to Me! emphasizes the importance of engaging in shared reading right from birth.

The findings of this study are important because it is one of the few to study literacy interventions targeted at newborns and show that they are successful. Read to Me! has many aspects which make it unique from other book-gift programs aside from the age-group it targets. Read to Me! is given at the hospital bedside which is a near universal delivery point and allows this program to be delivered to virtually every child born in the hospital. Read to Me! is also an inexpensive and easily delivered intervention. The cost of a single bag which contains 2 children’s books, a book with nursery rhymes, a CD with nursery songs, information about libraries and other literacy resources, and the bag itself is $27.19 CDN. The Read to Me! bag is now also available in Mi’ kmaq and Arabic in addition to English and French.

Further research needs to be conducted to evaluate the types of interactions parents are having with their infants during shared book reading as well as a comparison of book behaviours in children who did receive an intervention compared to those who did not. A longitudinal evaluation of children who received book-gift bags as infants should be conducted to determine if these interventions have an impact on fostering long-term positive associations with reading and on later language and literacy abilities.

This study has several strengths. Firstly, the sample size for both the intervention and control groups was large. It was not possible to have equal numbers in both groups due to the difference in population size of the two geographic areas from which the participants were recruited. Secondly a wide variety of language and literacy based activities were included and both duration and frequency with which mothers engaged in both active and passive activities was explored.

The study did have several limitations, including the fact that it was a non-randomized study which was dependent on self-report. The proportion of babies aged 4–6 months was slightly higher in the control group. It would be expected that if anything this difference in age would make the differences between the control and intervention groups smaller because older age was a predictor of more frequent engagement in literacy activities. Given the differences in recruitment between the intervention and control groups, there may have been selection bias present in the control group because recruitment was via mail requests with a follow-up phone call from the ward clerk. However, given the large sample size of the interventions group, which was recruited prior to the control group, it was felt that the recruitment method was appropriate to increase the sample size of the control group as much as possible.

Numerous other variables such as the number of siblings in the home, the style of reading and age-appropriateness of books may influence the mother’s engagement in literacy activities and effects of the engagement. These should be explored in future studies but were beyond the scope of this paper.

In summary, we have demonstrated that Read to Me! may be an inexpensive, easy to administer and effective intervention resulting in increased shared reading of mothers and their newborns.