Early Literacy Research Library (ELRL) - Article

Improving Early Childhood Literacy and School Readiness through Reach Out and Read (ROR) Program

Thakur, K., Sudhanthar, S., Sigal, Y., Matterella, N. (2016) Improving Early Childhood Literacy and School Readiness through Reach Out and Read (ROR) Program. BMJ Quality Improvement Reports, 5(1), 1-4. ,

Access: FREE/Open Access

Publication year


study description

Quality improvement project.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Medical Providers , Medical Trainees , Poverty/Low-Income , Toddler/Preschool , Urban

Exposures, Outcomes, Other

Anticipatory Guidance , Implementation and Evaluation , Parent Behaviors and Skills , Provider Behaviors and Skills , Reading Frequency , School Readiness and Educational Outcomes


The aim of this project was to improve the rate of distribution of books and physician advice about reading, to the families at each well child visit in the age range of six months to five years.


Reach Out and Read (ROR).

outcomes evaluated

Provider provision of books and anticipatory guidance, and parental reading frequency.


A large inner-city pediatric residency clinic serving a lower socio-economic status under-served population.


A workflow was created to efficiently distribute books at well visits. A presentation about the ROR program was attended by all the physicians and residents. Reading tips in each exam room were posted to serve as a reminder for all providers and for the parents. A three question survey was collected from the families at the end of their well visit.

sample size

n=200 (surveys, baseline); n=210 (surveys, post intervention)


Measure of Resource Provision and Reading Behaviors: baseline and post intervention survey asking parents:

    • Did you receive an age appropriate book for your child?
    • Did your physician discuss about good reading habits?
    • How often do you read to your child?


A total of 210 surveys were collected from parents over a six month period. The percentage of handing out books at all well child visits increased from 30% to 96%. The rate of providers giving advice about the benefits of reading increased from 26% to 87%. The percentage of parents reading to their child greater than four days per week increased from 56% to 80%.


Reading aloud is widely recognized as the single most important activity leading to literacy acquisition. With the above interventions, families participating in the ROR model at our clinic were more likely to read to their children, more likely to report reading aloud at bedtime, and to read aloud four or more days per week.


The most significant barrier for this project was for the clinic administrative staff to remember to place a book with the chart. This was overcome by having the staff pick a book first before going to room in the patient. Another barrier encountered was for the residents to remember to talk about reading. Charts and posters supporting reading in the examination rooms, relocating the placement of age appropriate books to the resident conference room, and a reminder from supervising faculty, helped to overcome this problem.