Flashcards in Read, speak, sing: Promoting literacy in the physician’s office Deck (21):
How many working age adults in Canada have low literacy?
What percentage of Canadians 16-65yo do not have minimum literacy skills (high school level)?
What percentage or prison inmates have low literacy skills?
What percentage of immigrants have low literacy?
What percentage of native-born Canadians have low literacy?
What percentage of Aboriginal people 15-49yo have less than a grade nine education?
What are the direct effects of low literacy on health?
1. Incorrect use of medications
2. Failure to comply with medical directions
3. Errors in administration of infant formula
4. Safety risks in the community, the workplace, and at home
What are indirect associations between low literacy and health?
1. Higher rates of poverty
2. Higher than average rates of occupational injuries
3. Higher degrees of stress
4. Unhealthy lifestyle practices such as:
b) poor nutrition
c) infrequent physical activity
d) lack of seatbelt use or wearing of bicycle helmets
e) less prevalence of breastfeeding (where applicable)
f) less likely to ever have had a blood pressure check
g) (among women) less likely to practice breast self-examination and to obtain pap smears
5. Limited access to and understanding of health information
6. Inappropriate use of medical services
What are early language skills primarily based on?
What is the evidence regarding the roles of physicians in promoting literacy?
1. Parents want information from physicians about learning. Nearly one-half of parents who do not read daily believe it would be helpful to discuss literacy with their paediatrician
2. Parents receiving the ROR intervention are four to 10 times more likely to read frequently (at least three days/week) to their children. The effect is greatest among the poorest families, suggesting the intervention is most beneficial to those who need it the most.
3. Parents often place more importance on reading to their children when a book is given by a paediatrician. The distribution of books enhances the effectiveness of literacy intervention beyond what is achieved by anticipatory guidance alone.
4. Preschoolers receiving the intervention have higher receptive and expressive language scores on standardized tests.
5. There is a dose-response relationship between exposure to a literacy promotion intervention and desired literacy-related behaviours.
6. Parents rate physicians who demonstrate reading aloud and give books as more ‘helpful’
What are the CPS recommendations to promote literacy?
1. Addressing low literacy as a child health problem beginning at birth and continuing through adulthood.
2. Inquiring about family literacy orientation at regular health care visits. Questions could include the frequency of book sharing, access to children’s books in the home, use of books in children’s routines and caregivers’ literacy levels.
3. Including literacy promotion in their routine clinical practice. Interventions should include: anticipatory guidance regarding literacy development; provision of tools such as developmentally appropriate books if possible, or library card applications and a prescription to read a fun book; and referral to adult literacy services as required.
4. Encouraging parents and all child care providers to look at books daily with their children beginning at birth and to create and maintain a literacy-rich environment for their children both at home and in all other child care settings (eg, daycare, preschool). For caregivers with low literacy skills or who speak a nonlocal language, singing, storytelling and talking about pictures in their native language should be encouraged.
5. Encouraging families to get a library card and visit the library regularly.
6. Ensuring that clinic waiting areas encourage literacy. Culturally and age-appropriate reading materials, posters, information on literacy resources, and volunteer readers are ways to accomplish this. Infection control policies, such as the removal of visibly soiled books or cleaning book covers after use, should be considered.
What does the CPS recommendations regarding advocacy for literacy promotions?
1. The inclusion of anticipatory guidance regarding the importance of reading to children in standard health maintenance guidelines.
2. Training in literacy development and promotion for paediatric and family medicine residents through education governing bodies such as the Royal College of Physicians and Surgeons of Canada and university postgraduate medical education departments.
3. Alliances between physicians and literacy promotion organizations, such as the National Literacy Secretariat, ABC Canada, and the Canadian Language and Literacy Research Network to develop a national literacy promotion strategy. Physicians should work with childcare providers and literacy specialists at the community level to promote literacy locally. Contacting the local library to obtain library card applications is an appropriate first step.
4. An inventory, compiled by the Canadian Paediatric Society, of literacy resources available to physicians nationally and locally.
5. Government and private sector funding for the purchase of children’s books to be given out at well-child visits.
6. The appropriate allocation of funding for quality research in the prevention of low literacy.
What are the development milestones of early literacy at 6-12mo?
Motor function: reaches for book, bring book to mouth, sits in lap, holds head up steady
Cognitive/social ability: looks at pictures, vocalizes, pats picture. Prefers photographs of faces.
Interaction with parents: parents hold child comfortably, face-to-face gaze, parent follows baby's cues for "more" and "stop"
What are development milestones for early literacy at 12-18mo?
Gross motor: Holds book with help. Turns pages, several at a time. Sits without support. Able to carry book.
Cognitive/social ability: No longer mouths right away. Points at pictures with one finger. May label a particular picture with a specific sound.
Interaction with parents: Child gets upset if parent won’t give up control of book. Child may bring book to read. If parent insists that the child listen, child may insistently refuse.
What are development milestones for early literacy at 18-36mo?
Motor function: Turns one page at a time. Carries book around house.
Cognitive/social ability: Names familiar pictures. Attention varies highly. Asks for the same story over and over. ‘Reads’ books to dolls.
Interaction with parents: Parent asks “What’s that?” and gives the child time to answer. Parent relates book to child’s experience. Parent should be comfortable with fluctuating attention of toddler.
What are development milestones for early literacy at >3yo?
Motor function: Holds book without help. Turns normal thickness pages one at time.
Cognitive/social ability: Describes simple actions. Can retell familiar story. Plays at reading, moving finger from left to right, top to bottom. ‘Writes’ name (linear scribble).
Interaction with parents: Parents asks questions like “What’s happening?” Parent validates child’s response and elaborates on them. Parent does not drill child, but shows pleasure when child supplies word.
What are some examination room techniques to improve literacy?
1. Bring the book in early in the examination; do not save it for the end of the visit.
2. Hand the book to the child right away; observe how the child handles it, listen for language, and watch the parent-child interaction.
3. Listen for words elicited by the books and pictures; books allow for a wider range of vocabulary from young children.
4. Compliment the parent on the child’s interest in the book, the child’s ability to handle the book and turn pages, and the child’s potential as future reader.
5. Inquire about favourite books, and use of books in child’s routine.
6. Help parents see that their child’s interest in books is related to language development and intelligence.
7. Model reading aloud for parents (30 s to 50 s) and discuss what you are doing and why.
8. Incorporate the book and discussion of reading into established exam room routines like the physical examination or as a distraction during procedures (eg, immunizations).
What do infants 0-12mo like in books?
1. Board books with photos of other babies
2. Brightly coloured board books to touch and taste
3. Books with photos of familiar objects like balls and bottles
4. Small books sized for small hands
What do younger toddlers 12-24mo like in books?
1. Sturdy board books they can handle and carry
2. Books with photos of children doing familiar things like sleeping, eating or playing
3. Goodnight books for bedtime
4. Books about saying goodbye and hello
5. Books with only a few words on each page
6. Books with simple rhymes or predictable texts
What do older toddlers 24-36mo like in books?
1. Board books and books with paper pages
2. Rhymes, rhythms, repetitious text that they can memorize
3. Books about children, families, making friends, food or animals
4. Word books