Early Literacy Research Library (ELRL) - Article

Exploratory Mixed-Methods Study of a Primary Care Based Intervention Promoting Shared Reading During Infancy

Crosh, C.C., Barsella, A., Van Slambrouck, L., Notario, P.M., Li, Y., Parsons, A.A., Hutton, J.S. (2022) Exploratory Mixed-Methods Study of a Primary Care-Based Intervention Promoting Shared Reading During Infancy. Clinical Pediatrics (Phila), 61(7), 475-484.,

Access: Institutional Access

Publication year


study description

Exploratory mixed-methods study with a quasi-experimental design.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Infant/Newborn , Medical Trainees

Exposures, Outcomes, Other

Anticipatory Guidance , Home Language/Literacy/Learning Environment , Home Routines , Implementation and Evaluation , Parent Behaviors and Skills , Parent Knowledge, Attitudes, and Beliefs


This study explored efficacy of an intervention delivered during pediatric well visits promoting shared reading prior to 6 months old, in terms of home reading attitudes and routines.


Reach Out and Read (ROR)

outcomes evaluated

Home language environment (HLE) and parental attitudes.


Newborn well visits at a busy, resident run outpatient clinic in Advocate Children's Hospital (Oak Lawn, Chicago southwest side).


The intervention group received children's books and anticipatory guidance about benefits of shared reading, whereas the control group received general age-related anticipatory guidance. Surveys were administered at the child's newborn (pre-intervention) and 6-month (post-intervention) well visits. 

sample size

n=84 (families)


Measure of Home Language Environment (HLE): qualitative and quantitative survey analysis assessing the following:

    • Number of children’s books in the home.
    • Parent’s level of education.
    • Likert-based questions scored 0-3 asking parents to rate: “How important is it to read to your child?” and “How comfortable do you feel reading to your child?”
    • Multiple choice question regarding frequency of reading with the baby at home.


Significant findings at 6 months included more frequent shared reading (P = .03), greater comfort reading at this age (P = .01), and greater importance attributed to shared reading (P = .04) in the intervention group relative to controls.


These support the expansion of early literacy interventions such as ROR into early infancy.


As participation was optional, parents agreeing to participate may have been overly interested in shared reading during infancy compared with those with less interest (ie, participation bias), who may stand to benefit most from intervention....As with all studies based on parental report surveys, results are subject to social desirability bias. This may be reflected in near-maximal ratings of comfort and importance at both baseline and follow-up, which limited our ability to detect changes over time and between groups...It was infeasible within the study constraints (staff, funding) to verify whether parents had read with their infants, raising the possibility of reporting bias...Given limited resources typical of a resident trainee and to reduce burden on clinic flow, surveys were not administered at baseline to the control group, prohibiting groupwise comparisons at baseline and ability to control for this covariate at 6 months. An additional limitation was the relatively low levels of completion of 6-month surveys for the intervention group (56%), as well as the low level of documented delivery of guidance and books (7% at all 5 visits)...The level of documentation of delivery of guidance was also low (7%), which we believe was most likely a consequence of pediatric residents neglecting to record this within the EMR. This recording oversight was observed during the implementation of the study, despite multiple reminders and signs at the clinic. By contrast, actual delivery of the intervention (books and guidance) seemed robust, as by the end of the study the majority of books and handouts had been distributed. Finally, qualitative data were limited to one question, limiting insights into motivators less clearly aligned.