Early Literacy Research Library (ELRL) - Article

Improving Early Literacy Promotion: A Quality-Improvement Project for Reach Out and Read

Khandekar, A.A., Augustyn, M., Sanders, L., Zuckerman, B. (2011) Improving Early Literacy Promotion: A Quality-Improvement Project for Reach Out and Read. Pediatrics, 127(4), e1067-e1072.,

Access: Institutional Access

Publication year


study description

Quality improvement.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Medical Providers

Exposures, Outcomes, Other

Anticipatory Guidance , Child Development (general) , Provider Behaviors and Skills , Provider Knowledge, Attitudes, and Beliefs , Technology and Digital/Screen-Based Media


To improve the rates of age-appropriate book-giving during well-child care and the delivery of ROR-recommended anticipatory guidance in 6 pediatric clinics.


Reach Out and Read (ROR).

outcomes evaluated

Provider provision of books and anticipatory guidance (AG), and provider behaviors, attitudes, and satisfaction with ROR.


6 practices already participating in the ROR program in Massachusetts from the state ROR coalition database. All of them served patient populations that were culturally and economically diverse.


Three quality-improvement cycles were completed at each site. Practice-level data were shared with participants in iterative sessions to identify methods for improving care. A provider-training DVD was used to promote these ROR activities.

sample size

n=28 (providers, initial); n=31 (providers, final)


Measures of Provision, Behaviors, Attitudes, and Satisfaction:

    • surveys to assess degree to which parents report receiving selected ROR activities.
    • audits to review the number of eligible visits.
    • book inventory audits to assess the actual distribution of books within the practice.
    • provider self-assessment of their ROR practice.


Over the course of the project, the median rate of book-giving increased from 97% to 99% and for anticipatory guidance remained at 89%. Providers reported significantly improved ROR-related skills, particularly self-efficacy for modeling reading aloud and for using children's books to assess development.


Baseline adherence to the ROR program is high, possibly because of the ease of implementation. Quality improvement for ROR is feasible and may be easier to implement for book distribution than anticipatory guidance, although providers reported improved anticipatory-guidance skills. Future quality-improvement efforts should continue to address giving books and anticipatory guidance, both of which are integral to the ROR model.


Not discussed.