Early Literacy Research Library (ELRL) - Article

Effectiveness of a Clinic-Based Early Literacy Program in Changing Parent-Child Early Literacy Habits

Fricke, J., Navsaria, D., Mahony, K. (2016) Effectiveness of a Clinic-Based Early Literacy Program in Changing Parent-Child Early Literacy Habits. Washington Medical Journal, 115(6), 300-305.,

Access: FREE/Open Access

Publication year


study description

Cross-sectional survey

core topic(s)

Reach Out and Read (ROR)

Exposures, Outcomes, Other

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


This study evaluated parent attitudes and behaviors of early literacy related to ROR participation in Wisconsin clinics.


Reach Out and Read (ROR)

outcomes evaluated

Parent attitudes and behaviors of early literacy.


Statewide survey of non-academic clinics throughout Wisconsin.


A survey of early literacy attitudes and behaviors was administered to parents of children ages 6 months to 5 years in 36 Wisconsin clinics. Ten clinics were established ROR sites (intervention group) and 26 clinics had applied to become ROR programs but had not yet initiated the program (control group).

sample size

n=36 (clinics total); n=10 (ROR clinics); n=26 (pre-ROR clinics); n=1025 (surveys total)


Measure of Literacy Attitudes and Behaviors: paper survey administered in waiting room that assessed demographic information and six core questions based on those used by Needlman et al:

    • Questions 1-3: ranked whether or not respondents mentioned “reading” or “books.”
    • Questions 4-6: based on StimQ questionnaire for validity and reliability.


Parents at clinics with ROR programs were more likely to read with a child under the age of 6 months (OR=1.58, 95% CI, 1.05-2.38). Other literacy metrics trended toward improvement but none reached statistical significance. Paradoxically, the odds of parents reporting reading as a bedtime habit were decreased among those who participated in ROR.


Our study finds mixed support of the effectiveness of ROR outside of academic settings. The apparent discrepancy between these results and those from national studies on ROR may be related to differences in respondent demographics and educational attainment or differences in program implementation and fidelity. We believe that the results will become clearer with future study as clinics are prospectively evaluated over time rather than being compared to non-ROR clinics in a cross-sectional snapshot.


The percentage of respondents with college education or higher (54.5% and 59.9% of control and interventional groups, respectively) is notably higher than the Wisconsin state average of 37.8%. As previous studies have noted, ROR has its most dramatic impact among families with lower educational attainment. It is possible that our sample captured a disproportionately high percentage of Wisconsin. Approximately 80% of respondents in this study were white, compared to 72% of the US population and 86% of the general population Wisconsin. Needlman et al found impact of ROR among African-Americans and Latinos, but not whites, participating in ROR. The small number of nonwhite participants in our surveys limits sub-analysis based on race. However, given the large percentage of whites in our population relative to the study by Needlman, results from this study would be expected to be less pronounced than those results. It is likely that control group clinics had not implemented ROR programs until now because the need was not as great or apparent as it was for early adopters of the program, many of which were community health centers or located in poorer communities. Despite being a statewide survey, the sample was not comprehensive and only included a small portion of the more than 150 ROR programs in Wisconsin. The rate of parents declining to participate is unknown. It is likely that the written format of the survey discouraged or prevented some parents from participating—particularly those with low literacy skills. This study raises the question of whether paper surveys are sufficient and effective tools in evaluation of the impact of ROR in nonacademic settings. Although imperfect, the paper survey offers significant convenience and cost savings when compared with use of trained interviewers; however, their validity needs to be evaluated.