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Early Childhood Learning and the Pediatrician

A Qualitative Study Among Diverse, Low-Income Caregivers

Steinberg, Jecca Rhea MSc*; Bruce, Janine S. DrPH, MPH; Marin-Nevarez, Paloma BA*; Phan, Kimmy*; Merrell, Sylvia Bereknyei DrPH, MS*,‡; Chamberlain, Lisa J. MD, MPH

Journal of Developmental & Behavioral Pediatrics: June 2018 - Volume 39 - Issue 5 - p 376–386
doi: 10.1097/DBP.0000000000000564
Original Articles

Objective: School readiness by kindergarten entry is associated with increased high school graduation, decreased juvenile arrest, and better long-term health. Inadequate early childhood learning (ECL) disproportionately affects low-income children. Pediatricians have near-universal access to children younger than 5 years but remain an underused ECL resource. This study examined caregivers' perceptions of ECL, the role of the pediatrician and pediatric office, and the use of community-based ECL resources among diverse, low-income caregivers whose children were not enrolled in preschool.

Methods: Using community-engaged strategies, caregivers were recruited to participate in in-depth focus groups (FGs). Demographic and FG data were collected in English, Spanish, and Vietnamese. Qualitative data were analyzed with iterative transcript-based coding and theme analysis.

Results: From June 2015 to August 2015, 69 low-income mothers (n = 46), fathers (n = 8), and grandparents (n = 15) from African-American (33%), Latino (32%), and Vietnamese (35%) communities participated in 12 FGs. Caregivers across groups wanted pediatricians to act as ECL experts and to provide ECL services. Caregivers valued ECL, especially when delivered by trusted sources. Utilization and perception of community ECL resources varied among groups. The greatest variation included different preferences for resource setting, accessibility, and acceptability, especially cultural acceptability. Each individual and groups' unique, and occasionally adverse, experiences and financial and logistical considerations informed ECL preferences.

Conclusion: This exploratory study brings forth diverse caregivers' perspectives regarding the role of pediatricians in ECL and their desire for pediatricians to be an access point for high-quality, affordable ECL services. Caregivers' preferences regarding ECL programming may inform clinic-based pediatric ECL programming.

*Pediatrics Department, Stanford University School of Medicine, Stanford, CA;

Pediatrics Department, Pediatric Advocacy Program, Stanford University School of Medicine, Stanford, CA;

Department of Surgery, Stanford University School of Medicine, Stanford, CA.

Address for reprints: Jecca Rhea Steinberg, MSc, Stanford School of Medicine, 1265 Welch Rd, Palo Alto, CA 94305; e-mail:

All phases of this study were supported by Stanford School of Medicine Medical Scholars Funding, The Silicon Valley Community Foundation, and The Bella Vista Foundation.

Disclosure: The authors declare no conflict of interest.

Received October 10, 2017

Accepted February 31, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.