Link to full text: https://pubmed.ncbi.nlm.nih.gov/31978286/
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Download the full text: Burton_2019_Evaluating the Effect of Reach Out and Read on Clinic Values, Attitudes, and Knowledge
study descriptionQualitative descriptive evaluation
core topic(s)Reach Out and Read (ROR)
Population CharacteristicsMedical Providers , Rural , Urban
Exposures, Outcomes, OtherImplementation and Evaluation , Parent-Provider Relationships/Interactions , Provider Knowledge, Attitudes, and Beliefs
objectivesTo evaluate the effect of Reach Out and Read program implementation on clinic staff and clinic values, attitudes, and knowledge related to early literacy. The hypothesis of this study was that Reach Out and Read implementation not only improves early childhood literacy promotion, but also improves aspects of the clinician’s work environment. Understanding the potential effects of this program on clinic staff is important, since many clinics will implement this program in the near future.
exposureReach Out and Read (ROR)
outcomes evaluatedClinic values, attitudes, and knowledge related to early literacy.
settingWisconsin clinics that have had Reach Out and Read in effect for at least 1 year and a control group consisting of Wisconsin clinics that had applied for Reach Out and Read but were preimplementation. The clinics in both groups were distributed geographically throughout rural, urban, and suburban Wisconsin and included a mix of independent, academic, community, and federally qualified health centers, as well as clinics that are a part of larger health care systems.
methodsSemi structured key informant interviews were performed with 10 study clinics with Reach Out and Read and 7 control clinics. Interviews were transcribed, coded, and analyzed according to standard qualitative research protocol. Comparisons were made for differences in clinic morale and attitudes towards early childhood literacy. A secondary analysis examined practice and workplace changes in study clinics.
sample sizen=10 (study clinics); n=7 (control clinics); n=17 (total clinics)
resultsThe coded transcripts showed that clinicians at the majority of the study clinics believed that the program boosted clinic morale, increased provider satisfaction, improved patient-clinician relationships, and promoted a literacy-rich environment. Compared to clinicians in control clinics, clinicians in study clinics were more likely to report that they played a large role in promoting literacy and reported having more consistent literacy discussion in visits. Funding was the only concern mentioned consistently by clinics with Reach Out and Read.
conclusionsUnderstanding potential changes that can occur in clinics because of the Reach Out and Read program is crucial to help clinics adequately prepare for the implementation process. Knowing that this program has many advantages and few disadvantages in clinics may encourage more participation. Further studies should compare clinics with Reach Out and Read to those with no interest in the program to determine if results from this study can be more broadly generalized.
limitationsThis is a small qualitative study. Clinics in application for the program were chosen for the control group because there may be some fundamental differences between clinics interested in applying for a program like Reach Out and Read and those that are not interested. Clinics that were already motivated to implement the program were utilized in order to more directly examine the changes that occurred in clinics as a result of Reach Out and Read implementation. This does lead to the possibility that the control group may not be representative of all clinics, and the same results may not be seen among a group of clinics with no previous knowledge or interest in the program. In the future, it would be useful to perform a similar study comparing clinics with Reach Out and Read and clinics that have not expressed any interest in the program to see if the results are consistent with the findings of this study. In addition, these were individuals’ opinions and may not represent the opinions of all individuals working at a particular clinic, especially since the interviewees were likely to be program advocates. Another limitation of this study is potential social desirability bias. Although the clinics were explicitly informed that everything stated in the interview would remain confidential, there may have been reluctance to give negative feedback, especially given the involvement of the medical director of Reach Out and Read Wisconsin, although he only saw anonymized transcripts. In addition, as many of the clinics interviewed are affiliated with UW Health, results may be biased towards a more positive experience as this organization provides full funding for Reach Out and Read. Since this was a self-report study, it is possible the key informants did not provide entirely accurate descriptions of their program use. Selection bias was introduced by the research team in the creation of strict exclusion/inclusion requirements for this study. In addition, due to study limitations, only 1 coder analyzed the interview transcripts.