Early Literacy Research Library (ELRL) - Article

Enhancing Reach Out and Read with a Video and Text Messages: A Randomized Trial in Low-Income Predominately Latino Sample

Jimenez, M.E., et al. (2021) Enhancing Reach Out and Read with a Video and Text Messages: A Randomized Trial in a Low-Income Predominantly Latino Sample. Academic Pediatrics, 21(6), 968–976. ,

Access: FREE/Open Access

Publication year


study description

Mixed methods hybrid type I effectiveness-implementation randomized trial.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Poverty/Low-Income , Race, Ethnicity, and Culture

Exposures, Outcomes, Other

Home Language/Literacy/Learning Environment , Parent Behaviors and Skills , Parent Knowledge, Attitudes, and Beliefs , Reading Frequency , Technology and Digital/Screen-Based Media


To determine the effect of adding a video and text messages to Reach Out and Read (ROR) on parent-reported literacy activities compared to the standard version.


Reach Out and Read (ROR) enhanced with a video and text messages.

outcomes evaluated

Parent literacy activities and shared reading frequency.


The study was conducted at a Federally Qualified Health Center (FQHC) in New Brunswick, New Jersey from January 24, 2018 to August 31, 2019. Nearly all patients served at the FQHC come from low-income backgrounds, with 98% of patients at or below 200% of the Federal Poverty Guideline. Seventy-one percent of patients identify as Hispanic/Latino.


We conducted a mixed methods hybrid type I effectiveness-implementation randomized trial in a community health center that serves low-income Latino families. We assessed shared reading frequency and the StimQ Reading subscale, at enrollment and 6-month follow-up and the StimQ Parent Verbal Responsivity subscale, Parent Reading Belief Inventory, and Survey of Wellbeing of Young Children-Milestones at follow-up. We randomized 160 parent-child dyads to ROR or ROR plus video and text messages (enhanced ROR). We collected process data on ROR and engagement with texts. We interviewed 15 enhanced ROR participants. We analyzed quantitative data using regression and qualitative data using immersion/crystallization.

sample size

n=160 (parent-child dyads, total); n=15 (interviewed)


Process Measures:

    1. Receipt of ROR: parents asked 3 questions about ROR implementation (receipt of reading instructions, example of how to read with child, receipt of book).
    2. Text Message Engagement: monitored how many parents remained enrolled in messages and how often they responded to the texts.

Outcome Measures:

    1. Shared Reading Frequency: parental response to “In the past week, how many times did you read to your child?”
    2. StimQ Reading and Parent Verbal Responsivity (PVR) Subscales: measure of home cognitive environment including home literacy environment and verbal responsivity.
    3. Parent Attitudes About Reading: via the Parent Reading Belief Inventory (PRBI) assessing teaching efficacy, positive affect, verbal participation, knowledge base, and resources.
    4. Developmental Delay Risk: via parent reported developmental screening tool, Survey of Wellbeing of Young Children (SWYC) milestones.


One hundred thirty-seven parent-child dyads completed the study (87% Latino, mean child age 9 months). We found differences in the StimQ Reading subscale (B = 0.32; P = .034) and marginal differences in attitudes about reading favoring enhanced ROR. Between-group differences for shared reading frequency, verbal responsivity, and developmental delay were not significant. Qualitative themes provided insight into the enhanced ROR including how it encouraged parents, remaining barriers like competing priorities and lack of social support, and unanticipated benefits (ie, parent appreciation for attention on their families’ wellbeing).


A video and text message enhancement to ROR resulted in modest improvements in the home literacy environment over ROR alone. Additional strategies are needed to overcome potent barriers faced by low-income families.


The study occurred in one FQHC with families from largely low-income Latino backgrounds, so our findings may not generalize to all settings. Future work, at multiple sites should examine to what extent the effect of such enhancements differs based on fidelity to ROR. While beyond the scope of this study, examining heterogeneity of outcomes based on country of origin can also provide important insight. Our study was powered to identify an effect size of 0.5 SD and thus was underpowered to detect smaller effect sizes that are considered meaningful by the American Academy of Pediatrics and commonly found in more costly, intensive early childhood interventions. 34 Future studies with larger sample sizes are needed. We used parent-reported measures, which introduce the possibility of social desirability and recall bias. Additionally, participation in a study focused on shared reading may have itself influenced this behavior. Further, we only assessed home literacy activities among the primary caregiver and it is possible that others within the home engage in these activities. We also did not examine to what extent the primary caregiver or others in the home engage in reading themselves. Such an emotional connection could be an important determinant of shared reading and warrants future study. We also did not use observational measures of child development but given the age of the children enrolled and the brief follow-up period, there was likely insufficient time to observe differences. Future longitudinal work can address this limitation. Future work should also tease apart the effects of the different intervention components (ie, video vs text).