Texts enhanced pediatric literacy promotion

Text reminders and resource referral modestly improved developmental and parenting outcomes in Latino families.
*Parallel-group randomized controlled trial; Level 2 (OCEBM).

Citation

Jimenez ME, Hemler JR, Strickland PO, et al. Pediatric Literacy Promotion for Latino Families by Texts and Referrals: A 3-Arm RCT. Pediatrics. 2026;158(4):e2025075346.

Background

Primary care literacy promotion is standard pediatric care, but Latino children from low-income households still face early language and school-readiness gaps. This trial tested scalable additions to book-giving and reading guidance.

Patients

630 Latino caregiver-infant dyads from 3 New Jersey health centers; infants were 6 to 12 months old. Exclusions included planned loss of clinic care, inability to consent, congenital or genetic conditions linked to delay, or known developmental delay.

Intervention

Literacy promotion plus reading-focused text messages, or literacy promotion plus texts and referral to Connecting New Jersey for community resources.

Control

Literacy promotion only, using Reach Out and Read: books, reading guidance, and clinician modeling.

Outcome

Child language, social-emotional development, and parenting behaviors. Tools included MacArthur Bates Communicative Development Inventories, Devereux Early Childhood Assessment, StimQ2 reading scale (0 to 19), and verbal responsiveness scale (0 to 16).

Follow-up Period

9 and 18 months after enrollment.

Results

Comparison Significant outcome Time Effect
Texts vs control Child communicative development 18 months ES 0.391 (CI not reported)
Texts vs control Reading activities 9 months ES 0.415 (CI not reported)
Texts plus referral vs control Social-emotional development 9 and 18 months ES 0.267 and 0.300 (CIs not reported)
Texts plus referral vs control Verbal responsiveness 9 months ES 0.400 (CI not reported)

ES: effect size.

Analyses followed intention-to-treat principles. The control was current standard literacy promotion care.

Limitations

Findings may not generalize beyond Latino families in similar health centers. Outcomes relied partly on caregiver report. COVID-19 disrupted clinic literacy environments and community-resource staffing. Effect sizes were modest, and patient-important differences for these measures are uncertain.

Funding

NIH and Robert Wood Johnson Foundation; unpaid program advisory roles noted.

Clinical Application

Consider adding culturally tailored reading texts; referral integration may help social-emotional outcomes, but evidence is population-specific and not practice-changing alone.