Early Literacy Research Library (ELRL) - Article

Clinic-Based Intervention to Promote Literacy

Needlman, R., Fried, L.E., Morley, D.S., Taylor, S., Zuckerman, B. (1991) Clinic-Based Intervention to Promote Literacy: A Pilot Study. American Journal of Diseases of Children, 145(8), 881-884.,

Access: Institutional Access

Publication year


study description

Pilot, nested case-control study.

core topic(s)

Reach Out and Read (ROR)

Exposures, Outcomes, Other

Anticipatory Guidance , Parent Behaviors and Skills , School Readiness and Educational Outcomes


The purpose of this pilot study was to assess parental response to the clinic-based literacy program, and associations between exposure to the program and increased book use by parents and children.


Reach Out and Read (ROR).

outcomes evaluated

Parent reading behaviors and literacy orientation.


Boston City Hospital Pediatric Primary Care Center.


A clinic-based program was designed to encourage early book use among parents of children at risk. It included (1 ) waiting room readers, (2) guidance about literacy development, and (3) provision of children's books at each visit.

sample size

n=79 (parents)


Measure of Reading Behaviors and Literacy Orientation (LO): survey including questions about the following topics:

    • provide a 24 hour “activity recall” including everything they did with their child (positive LO score for looking at books/magazines).
    • what the child’s 3 favorite activities are, excluding eating and sleeping (positive LO score if looking at books among top 3).
    • use of books with child and number of books in the home.
    • parental reading habits, history of having been read to during childhood, and parental literacy level.
    • recall if at previous clinic visits they had seen volunteer readers, spoken with their provider about books or reading, or had been given a free book by their provider.


Seventy-nine parents of children aged 6 to 60 months were interviewed. Parents who had previously received a book were more likely to report looking at books with their children or that looking at books was a favorite activity (adjusted odds ratio, 4.05). This association was strongest among parents receiving Aid to Families With Dependent Children (odds ratio, 7.8).


This preliminary study suggests that pediatricians can play a role in enriching children's early literacy environments, especially for children at high risk of school failure.


First, although the interviewer attempted to enroll all eligible parents, it is possible that parents less responsive to the intervention were missed with greater frequency. This bias would have led to overestimation of intervention effects. Second, the study relied on parents self reporting, raising the possibility that observed differences may have reflected parental perceptions or priorities rather than actual behavior. The possibility of bias is introduced because of systematic differences in reporting between groups of parents cannot be excluded. Third, the fact that patients were not randomized increases the chance that observed associations resulted from confounding. Although several factors likely to be confounders were included in logistic regression model, we cannot exclude confounding by unmeasured factors . For example, parents who were more highly motivated to provide literacy stimulation for their children might also have been more vocal in requesting books, which could explain the apparent association between taking home a book and literacy orientation. Finally, small sample size may have resulted in type 2 errors in the stratified analysis. It is possible that with larger sample sizes, additional subgroups of parents who responded positively to the program would have been identified.