O2041: Enhancing an Inpatient Early Literacy Program through a Diversity, Equity, and Inclusion Lens: Heart of a Bookworm Expanded

Background: Children with congenital heart disease (CHD) are at risk for neurodevelopmental delays. The American Academy of Pediatrics encourages reading to children in infancy to stimulate brain development. Early childhood literacy programs have been a cornerstone of outpatient care to promote early literacy, but hospitalized children miss out on this opportunity. The “Heart of a Bookworm” (HOAB) program is a quality improvement project at Norton Children’s Hospital promoting early literacy in patients with CHD through inpatient reading and book distribution. Since 2021 over 4,000 books have been read to children in the hospital.

Studies have uncovered disparities in children’s pre-literacy skills and reading exposure based on parental education level, socioeconomic status, and racial and ethnic backgrounds. Children of immigrant parents have been reported to have lower book sharing practices with disproportionate impacts on Latinx families. It is important to have a diverse representation in child literature to promote self esteem and nurture curiosity and empathy.

Project Description: The goal of this project was to create a more diverse and equitable experience in early literacy for all CHD patients enrolled in HOAB, including underrepresented minorities and non-English speaking children.

To achieve this, we took a multi-faceted longitudinal approach focused on three key areas (Figure 1): 1. PARTNERSHIP: We partnered with local libraries, Office of Diversity and Inclusion (OD&I), and medical Spanish group to evaluate our library wish list, identify diverse community partners, and plan future hospital-based reading events. 2. ACCESS: Create a culturally and ethnically diverse library with expanded language selection. We edited our book wish list based on OD&I recommendations and our reading logs to include QR codes that access online libraries with diverse language options. 3. REPRESENTATION: Utilize Spanish speaking volunteers to read to Spanish speaking children. We will create a diverse representation for our future reading event book selection and readers.

Discussion: This project describes the early stages of longitudinal growth of an early literacy program to become more focused on diversity, equity, and inclusion. One notable change since program implementation has been an increase in the mean rate of books read to Spanish speaking patients. These programs can be enhanced and diversified by creating community and institutional partners. Ensuring that an already vulnerable population has adequate representation increases involvement of these patients in recommended developmental activities and promotes early literacy after hospitalization.

Conclusion: Reading to children enhances early literacy and childhood development. Inpatient reading programs can successfully expand early literacy in patients with CHD. It is important for these programs to recognize opportunities to close the racial and ethnic disparities in early childhood literacy.