Primary care-based literacy promotion enhances caregiver-child shared reading and child language outcomes, yet variation in implementation may dilute its impact. This study examines expert perspectives on intended outcomes of literacy promotion, as well as its core components, those necessary to achieve intended outcomes, and components that are recommended but adaptable to context. We purposively sampled health care and policy experts in primary care-based literacy promotion from the United States and Canada for online, in-depth interviews. Interviews were recorded, transcribed verbatim, and analyzed iteratively, engaging emergent and a priori codes based on the Components and Rationales for Effectiveness fidelity method and the team's prior work to identify themes. We achieved saturation after 22 interviews with 24 participants (16 US participants, 8 Canadian). We identified 4 themes: 1) Traditionally, literacy promotion focused on enhancing preliteracy skills and school readiness. Over time, this outcome has evolved to include fostering early relational health as a foundational goal; 2) core components include a trusted clinician delivering a strength-based, family-centered message, while modeling developmentally-informed shared reading; 3) components that are adaptable to setting and context include literacy-rich clinical environments and community resource referrals; 4) experts diverged on whether providing a children's book during literacy promotion is essential, but there was congruence that book provision alone is insufficient. Experts identified strength-based, family-centered guidance from a trusted clinician with developmentally-focused modeling as core to support intended outcomes of early relational health and school readiness. This understanding can inform training and health care improvement activities aimed at optimizing primary care-based literacy promotion.

Ready and Healthy for Kindergarten is a Spanish/English multilingual family involvement program that is grounded in sociocultural and family literacy theories since it focuses on health and literacy development. The program’s development reflects a collaborative partnership of teachers, pediatricians, families, and an advisory board of multilingual parents dedicated to preparing preschoolers and their families for kindergarten. Health themes are presented to introduce foundational literacy and social-emotional skills, and the program comprises eight one-hour virtual sessions intended to engage both children and their families through active participation in learning. The program highlights how parents, educators, and pediatricians can come together to align their expertise and impact family knowledge around child development needs. With this strong collaboration when designing and implementing the Ready and Healthy for Kindergarten program, we were able to successfully provide guidance and support for families, which helped them to establish routines that promote health and well-being, along with some literacy skills.

South Asian (SA) Americans have a high risk of metabolic and cardiovascular disease. Prevention efforts should start in childhood and should be culturally appropriate. We sought to understand the challenges and barriers that pediatricians face in providing care for SA children to inform professional education on culturally effective care. Qualitative interviews were conducted with a diverse sample (N = 17) of pediatricians. Challenges reported included feeding problems, inadequate physical activity, and mental health concerns. Communication barriers included parents’ anxiety around feeding, influence of grandparents, stigma around mental health, and cultural communication gaps. Effective strategies included clear communication, a gradual approach, ensuring buy-in from grandparents, greater attention to family history, and improved cultural knowledge in pediatrician. Addressing feeding problems was the most mentioned challenge, which is especially concerning given the high chronic disease risk in SAs. Education on culturally appropriate strategies can equip pediatricians to effectively counsel SA families to address these risks.

(1) Background: Obesity and dental caries disproportionately affect low-income South Asian (SA) immigrant children in the US. This CHALO! study aimed to reduce the risk of obesity and oral health risk in young SA children in the US. (2) Methods: CHALO! is a randomized controlled trial. A total of 350 low-income Bangladeshi mothers of 6-month-old children were recruited and randomized to intervention or control. Intervention participants received six home visits and six phone calls from trained community health workers who delivered health education and support. The primary outcome was frequency of combined bottle/sippy cup use over 18 months measured via self-report. Secondary outcomes included sugar consumption, maternal feeding practices, oral hygiene practices, and dental utilization measured via self-report. Secondary clinical outcomes included the presence of dental caries at follow-up (12 months post baseline) assessed through intra-oral camera, and obesity risk, measured as weight gain velocity, at each 6-month period. (3) Results: Bottle/sippy-cup use increased less in the intervention group (Poisson rate ratio = 0.36, 95% CI: 0.34–0.39, p < 0.0001) vs. controls (Poisson rate ratio = 0.58, 95% CI: 0.56–0.61), and while consistent results were noted in sugar consumption, oral hygiene practices, dental visits, and other secondary outcomes, no difference was found in caries prevalence or weight gain velocity. (4) Conclusions: The intervention improved self-reported bottle use and child diet in the intervention group. There were no significant changes in caries prevalence or weight gain velocity. Social context, particularly social networks, may act as a barrier to adopting new healthy behaviors, impacting changes in caries and obesity outcomes.