Early Literacy Research Library (ELRL) - Article

Effectiveness of a Primary Care Intervention to Support Reading Aloud: A Multicenter Evaluation

Needlman, R.D., Toker, K.H., Dreyer, B.P., Klass, P., Mendelsohn, A.L. (2005) Effectiveness of a Primary Care Intervention to Support Reading Aloud: A Multicenter Evaluation. Ambulatory Pediatrics, 5(4), 209-215.,

Access: Institutional Access

Publication year


study description

Prospective intervention study.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Infant/Newborn , Kindergarten , Toddler/Preschool

Exposures, Outcomes, Other

Implementation and Evaluation , Parent Knowledge, Attitudes, and Beliefs , Reading Frequency


This study seeks to determine whether institution of Reach Out and Read (ROR) programs is associated with increased reading aloud in a national sample.


Reach Out and Read (ROR).

outcomes evaluated

Parent attitudes and practices around reading aloud.


A convenience sample of parents of children age 6–72 months seeking routine health care at 19 clinical sites in 10 states.


The study design was a before-after intervention study: separate convenience samples were studied before and after institution of ROR programs at multiple sites. The interventions included the ROR model that incorporates anticipatory guidance about reading aloud and distribution of free picture books at health supervision visits from 6 months through 5 years as well as reading aloud in the waiting room. The main outcome measures were parents interviewed about their attitudes and practices related to reading aloud, using questions drawn from validated instruments.

sample size

n=730 (intervention); n=917 (comparison); n=1647 (total)


Measure of Parental Literacy Attitudes and Practices: questions adapted from the StimQ including reading as a favorite activity, reading as part of the bedtime routine, reading as part of first grade readiness, days per week reading aloud, number of children’s books available in the home, etc.


Measure of Participating Health Centers: health center characteristics (setting, location, residents, insurance, social class) and the extent of ROR implementation.


After controlling for multiple potential confounding factors, significant associations were found between exposure to ROR and reading aloud as a favorite parenting activity (Adjusted Odds Ratio [AOR] 1.6,P,.001); reading aloud at bedtime (Adjusted Odds Ratio[AOR*rsqb; 1.5,P,.001); reading aloud 3 or more days per week (AOR 1.8,P,.001); and ownership of 10 picture books (AOR 1.6,P,.001).


In a national sample, implementation of ROR programs was associated with increased parental support for reading aloud. This study provides evidence of the effectiveness of a primary care intervention strategy to promote reading aloud to young children.


Despite being a national study, the sample was not intended to reflect the demographics of the country nor were sites chosen at random. Therefore, one must generalize with caution...The reliance on convenience samples raises the possibility of selection bias on the part of the interviewers. To the extent possible, this limitation has been addressed through multivariate analyses, controlling for potential confounding factors. Bias in the interpretation of the 3 open-ended questions could have contributed to the positive findings, but such bias is less likely to have affected the StimQ questions to the same degree because these did not rely on interviewer interpretation. Nonetheless, the fact that the interviewers could not be blinded to intervention status (the presence or absence of an ROR program) may have led to bias in the data collection. Social desirability may also have colored parents’ responses, contributing to reporting bias, although we asked open-ended questions first and phrased other questions so as to imply acceptance for nonreading aloud...The use of an historical comparison group raises the possibility that secular trends might account for the observed differences. However, data from the National Household Education Survey suggest that the pace of change in parental support for preschool literacy development has been slow in the country as a whole. Between 1993 and 1999, the percentage of parents of 3–5 year olds who reported reading aloud 3 or more days per week rose from 78% to 81%; among parents with less than a high school education, the percentage rose from 60% to 61%.2 Secular changes over the period of our study are likely to have been smaller yet."