Early Literacy Research Library (ELRL) - Article

Implementation of Reach Out and Read by Health Departments Increases Rural Access

Caldwell, A., Cooper, M.T., Dunlap, M. (2018) Implementation of Reach Out and Read by Health Departments Increases Rural Access. Journal of Oklahoma State Medical Association, 111(8), 796-800.,

Access: FREE/Open Access

Publication year


study description

Spatial analysis.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Poverty/Low-Income , Rural

Exposures, Outcomes, Other

Disparity/Adversity , Implementation and Evaluation


To evaluate how implementation of the ROR program in Health Departments affects access for at risk children.


Reach Out and Read (ROR).

outcomes evaluated

Geographic distribution and accessibility of ROR to children in rural areas, with high poverty levels, and with low education levels.


County Health Department or clinic practice ROR sites throughout Oklahoma.


Oklahoma program sites were classified as either Health Department or practice, geocoded, and mapped to census tract, census block group, and county subdivision maps. Sites were classified as rural or urban, and census data was used to classify sites as high or low poverty prevalence and education level. Sites were compared to determine their accessibility to at risk children as defined by living in rural areas, high poverty, and low educational level.

sample size

n=18 (health department sites); n=67 (practice sites); n=85 (total sites)


Measure of Geographic Distribution: census data used to classify sites as:

    • rural or urban using RUCA Codes
    • high/low education and poverty prevalence using TIGER/shapefile geodatabase


There were 18 Health Department and 67 practice sites. Health Department sites were more likely to be in rural areas: 13 of 18 sites versus 16 of 67 practices (p<0.001). They were less likely to be in areas of high poverty: 10 of 18 versus 61 of 67 practices (p<0.001), and they were not more likely to be in areas of lower education, with 8 of 18 sites in low education areas versus 34 of 67 practices (p=0.8342).


Implementation of Reach Out and Read in Health Departments in Oklahoma increased the number of rural program sites. Health Department locations were less likely to be in areas of poverty and lower education. Use of the program in Health Departments is an effective way to expand the program to serve rural children.


We used a narrow definition of rurality based on RUCA codes, and other classification strategies may have categorized larger areas of the state as rural. In addition, our study examined geographic distributions of sites but did not measure the number of patients reached by the program, and this should be an area of further study. Also, ROR in Health Departments has not been evaluated previously, and the use of the model may vary by Health Department... Finally, the distribution and function of County Health Departments may vary by state, which may limit generalizability of our findings.