Literacy Promotion Using Automated Hovering

Study Overview
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Brief Summary
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The purpose of this study is to incorporate behavioral economics approaches to determine whether 3 novel interventions of varying intensity improve the frequency of parent-child reading behaviors among low-income families. Participants will be randomized to comparative groups to test the effects of automated hovering approaches on frequency of parent-child shared reading. Investigators long-term goal is to test the effects of these approaches to promote child language and socio-emotional development.

Detailed Description
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Early childhood is a sensitive period in which young children develop language and socio-emotional skills foundational for school readiness. Unfortunately, poor vulnerable children experience disparities in these critical areas of development. Parent-child shared reading can help ameliorate these disparities, yet low-income parents do not consistently engage in this activity. Behavioral economics approaches utilizing automated hovering (AH) have the potential to increase parent-child shared reading through text messages and financial inducements. The study design is a prospective, randomized comparative group trial to test the effects of AH approaches to increase parent-child shared reading. A total of 45 eligible children and their parents will be recruited from participating practices to achieve a diverse sample of children. Forty-five participants in will be randomized 1:1:1 to receive one of the 3 AH interventions: 1) daily text message reminders, 2) daily text message reminders with coaching/social comparisons or 3) daily text message reminders with coaching/social comparisons and weekly lottery entries. All interventions are related to principles of behavioral economics in order to provide external motivation. There will be 15 participants per group to adequately assess feasibility and acceptability, the primary outcome. Descriptive statistics for demographic, home reading environment, and parenting stress measured at baseline will be examined across the three groups to assess the success of the randomization. To assess feasibility and acceptability, Investigators will assess the proportion of participants who receive and report a daily reading behavior each week across all groups, the proportion of participants who access coaching content in group 2 & 3, and the proportion of participants who participate in the weekly lottery in group 3, and satisfaction scores in all groups. Secondary outcomes including differences between groups in weekly reading frequency, home reading environment, and child socio-emotional scores between groups will be assessed using standard inferential statistics and intention-to-treat analysis. The results of this study may assist health care providers and researchers in testing the feasibility of AH approaches to improve parent-child shared reading and prepare for a larger efficacy trial.

Official Title
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Literary Promotion Using Automated Hovering to Improve Development in Young Low-Income Children

Conditions
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Parent-Child Relations, Parenting, Literacy

Intervention / Treatment
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* Behavioral: Text Messaging
* Behavioral: Coaching
* Behavioral: Lottery


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Parents who: Have an infant aged 6-24 months Have access to a smart phone with text messaging capabilities Have completed an informed consent Children who: Are aged 6-24 months old Exclusion Criteria: Parents who: 1. Non-English speaking Children who: Were born premature (estimated gestational age < 35 weeks) Have been diagnosed with congenital malformations or genetic syndromes which place them at risk for developmental delays

Ages Eligible for Study
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Minimum Age: 6 Months
Maximum Age: 24 Months

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The intervention consists of 3 intervention groups. Participants will be stratified by site and randomized 1:1:1 to receive one of the 3 AH interventions for an 8-week duration.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group 1: Text Messaging<br>Consist of daily text messages on shared reading | Behavioral: Text Messaging<br>* Text Messages will be sent to participants using Penn's Way to Health Platform. Participants will be asked to reply to daily text messages on daily shared reading activities including the titles of books and time spent reading.<br>|
| Experimental: Group 2: Text Messaging + Coaching<br>Will consist of Group 1 plus personalized coaching. | Behavioral: Text Messaging<br>* Text Messages will be sent to participants using Penn's Way to Health Platform. Participants will be asked to reply to daily text messages on daily shared reading activities including the titles of books and time spent reading.<br>Behavioral: Coaching<br>* Personalized coaching content will be made available to participants through links in the text messages and will provide comparisons of their reading frequency with that of other participants.<br>|
| Experimental: Group 3: Text Messaging + Coaching + Lottery<br>Will consist of Group 2 plus availability of a weekly lottery. | Behavioral: Text Messaging<br>* Text Messages will be sent to participants using Penn's Way to Health Platform. Participants will be asked to reply to daily text messages on daily shared reading activities including the titles of books and time spent reading.<br>Behavioral: Coaching<br>* Personalized coaching content will be made available to participants through links in the text messages and will provide comparisons of their reading frequency with that of other participants.<br>Behavioral: Lottery<br>* Participants who reply to a text message that they read on a particular day will be entered into daily and weekly drawings to receive cash payments.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants who respond to the intervention delivery | To determine feasibility, investigators will assess the number of participants who respond to daily text messages in each study arm, who access the coaching content in groups 2 and 3, and who participate in the lottery in group 3. | 2 months | 
| Overall participant satisfaction of intervention delivery | To determine acceptability, participants will be assessed on their overall satisfaction (5-point Likert scale 1=strong disagree and 5= strongly agree) with their study arm and answer survey questions regarding likes and dislikes concerning the intervention group they received following the intervention period. | 2 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Home Reading Environment | To determine change in home reading environment, Investigators will examine differences in the Read subscale of the measure of Cognitive Stimulation provided in the home (StimQ) from baseline to 2 months. The Read subscale of the StimQ is a validated 14-item parent self-report questionnaire designed to measure of the home reading environment for children ages 5 to 72 months of age. | 2 months | 
| Change in Parenting Stress | To determine change in parenting stress, Investigators will examine differences in the Parenting Stress Index- Short Form (PSI-SF) from baseline to 2 months. The PSI-SF is a validated 36-item scale that measures parenting stress, and it has been shown to have excellent internal consistency and to be positively associated with maternal psychological distress. | 2 months | 
| Weekly Parent-Child Shared Reading Frequency | Investigators will measure reading frequency as the average number of days per week of reported parent-child shared reading. Reading frequency will be determined by responses to daily text message reminders that report reading with a book title and duration. | 2 months | 
| Child Language Development | Investigators will measure child language development at 2 months using the MacArthur Communicative Development Inventory (CDI), a validated parent report scale of early child language development. | 2 months | 
| Child Socio-Emotional Development | Investigators will measure child socio-emotional development at 2 months using the Devereax Early Childhood Assessment (DECA), a validated 33-item parent report of social emotional problems. | 2 months |