Early Literacy Research Library (ELRL) - Article

Attendance at Well-Child Visits After Reach Out and Read

Needlman, R.D., Dreyer, B.P., Klass, P., Mendelsohn, A.L. (2019) Attendance at Well-Child Visits After Reach Out and Read. Clinical Pediatrics (Phila), 58(3), 282-287.,

Access: Institutional Access

Publication year


study description

Secondary analysis of data from a multisite national study.

core topic(s)

Pediatric Primary Care , Reach Out and Read (ROR)

Exposures, Outcomes, Other

Parent Behaviors and Skills , Parent Knowledge, Attitudes, and Beliefs


Attendance at well-child visits (WCVs) is a sine qua non of preventive care. We hypothesized that Reach Out and Read (ROR) would be associated with better WCV attendance.


Reach Out and Read (ROR).

outcomes evaluated

Well child visit (WCV) attendance.


Eight pediatric clinics in 4 states: California, Ohio, Louisiana, and New York.


Parents of children 76 to 72 months at 8 clinics who did not yet have ROR reported how many WCVs their child had attended in the previous year; separate samples at the same clinics were interviewed 16 months after the ROR program was instituted.

sample size

n=267 (parents; before); n=254 (parents; after); n=521 (total)


Measure of WCV Attendance and Reading Aloud: 15 question survey for parents asking questions about:

    • number of well-child visits to this center in the last 12 months
    • parental attitudes about reading aloud
    • parental practices about reading aloud
    • demographics (ethnicity, languages spoken at home, highest grade in school completed)


Comparing 267 parents before ROR and 254 after, the percentage who had attended the minimum number of WCVs required by the American Academy of Pediatrics periodicity schedule rose from 67.4% (180/267) to 78.3% (199/254; P < .01). This difference remained significant after controlling for multiple potential confounding factors (estimated odds ratio = 2.1, 95% confidence interval = 1.3-3.5). The largest differences were among Latino children and children of less-educated parents.


Programs to enhance early literacy may increase attendance at WCVs among at-risk families.


The present study relies on a secondary analysis of a dataset designed to answer questions about parental attitudes and behaviors related to reading aloud. Consequently, the dependent variable relies on a single question requiring parents to recall of the number of WCVs their child attended in the last 12 months. Because data were collected anonymously, we had no way to confirm these reports using medical records or insurance claims. It is possible that social desirability may have induced parents to inflate the number of WCVs they reported. Indeed, 67.4% of parents in our control group (before ROR) reported having had at least the recommended number of WCVs, a figure comparable to some previously published findings, but higher than others. Because of the reliance on parental recall, we cannot exclude the possibility that the intervention caused parents to remember having attended more visits, even though perhaps the objective facts were otherwise. Even if this were the explanation, the finding that WCVs that include ROR are more memorable to parents would be noteworthy. Because our study employs a historical control group, there is the possibility that secular changes in WCV attendance could account for the observed before-versus-after differences. Changes in state insurance coverage for low-income children might be particularly important... Although the sample was drawn from a geographically diverse area, no attempt was made to recruit a nationally representative sample; therefore, the ability to generalize from our findings is limited. We cannot directly translate our outcome measure, WCV attendance, into completeness of immunization, although it stands to reason that increased immunization would follow from an increase in opportunities to immunize.