Doc Says: Promoting School Readiness Through a Pediatric Clinic-Based Text Messaging Intervention

Lisa J. Chamberlain,
Janine Bruce,
Monica De La Cruz,
Lynne Huffman,
Jecca R. Steinberg,
Ren Bruguera,
Jaime W. Peterson,
Rebecca M. Gardner,
Zihuai He,
Yesenia Ordaz,
Elizabeth Connelly,
Susanna Loeb
Year of publication
148 (4)


Children entering kindergarten ready to learn are more likely to thrive. Inequitable access to high-quality, early educational settings creates early educational disparities. TipsByText, a text-message–based program for caregivers of young children, improves literacy of children in preschool, but efficacy for families without access to early childhood education was unknown.


We conducted a randomized controlled trial with caregivers of 3- and 4-year-olds in 2 public pediatric clinics. Intervention caregivers received TipsByText 3 times a week for 7 months. At pre- and postintervention, we measured child literacy using the Phonological Awareness Literacy Screening Tool (PALS-PreK) and caregiver involvement using the Parent Child Interactivity Scale (PCI). We estimated effects on PALS-PreK and PCI using multivariable linear regression.


We enrolled 644 families, excluding 263 because of preschool participation. Compared with excluded children, those included in the study had parents with lower income and educational attainment and who were more likely to be Spanish speaking. Three-quarters of enrollees completed pre- and postintervention assessments. Postintervention PALS-PreK scores revealed an unadjusted treatment effect of 0.260 (P = .040); adjusting for preintervention score, child age, and caregiver language, treatment effect was 0.209 (P = .016), equating to ∼3 months of literacy gains. Effects were greater for firstborn children (0.282 vs 0.178), children in 2-parent families (0.262 vs 0.063), and 4-year-olds (0.436 vs 0.107). The overall effect on PCI was not significant (1.221, P = .124).


The health sector has unique access to difficult-to-reach young children. With this clinic-based texting intervention, we reached underresourced families and increased child literacy levels.

Suggested Citation

Chamberlain, L.J., Bruce, J., De La Cruz, M., Huffman, L., Steinberg, J.R., Bruguera, R., Peterson, J.W., Gardner, R.M., He, Z., Ordaz, Y., Connelly, E., & Loeb, S. (2021). Doc Says: Promoting School Readiness Through a Pediatric Clinic-Based Text Messaging Intervention. Pediatrics, 148 (4)