Early Literacy Research Library (ELRL) - Article

Improving Reach Out and Read Implementation in the NICU

Poindexter, Natasha. (July 2023). Improving Reach Out and Read Implementation in the NICU (DNP Scholarly Project, East Carolina University). Retrieved from the Scholarship. (http://hdl.handle.net/10342/13020.),

Access: FREE/Open Access

Publication year


study description

Quality Improvement

core topic(s)

Early Literacy , Early Relational Health , Pediatric Primary Care , Reach Out and Read (ROR) , Shared Reading

Population Characteristics

Infant/Newborn , Medical Providers , Neonatal/NICU

Exposures, Outcomes, Other

Brain/Neurocognitive , Implementation and Evaluation , Medical Training/Education , Parent-Provider Relationships/Interactions


The research aimed to understand how NICUs function and identify the factors that either hinder or support the introduction of book programs.



outcomes evaluated

Surveys were conducted to gain insight into the operational dynamics of NICUs and identify barriers and facilitators to book program implementation.


Pediatric primary care


The survey was sent out to 11 NICU points of contact, expecting these contacts to forward the survey to NICU staff members. Questionnaires were distributed to NICU facilities employing ROR, those utilizing extra book initiatives, and those that do not incorporate any book program.

sample size

N=40 surveys completed by providers from 5 NICU sites


Early Literacy in the NICU Survey


Results showed that bedside registered nurses (RNs) were the primary initiators of ROR enrollment and took on the majority of parent education responsibilities. Barriers that reduce the implementation of these early literacy book programs listed in order of how often they were reported included lack of knowledge within medical teams, cell phone use by families, how often the parent visits or how involved they are in the care, and lack of access to books in a foreign language.


It is recommended to establish a ROR unit committee to serve as a liaison role in the ROR implementation model. Enabling a committee of registered nurses (RNs) to assume this responsibility expands the scope of education. This allows for direct input on execution and ensures steady leadership even in the face of staff changes.


Unexpected departure of a project group member, who initially secured the project site, posed a significant limitation. This led to a reimagining of the project concept and site. Scheduling conflicts and personal commitments caused delays in obtaining guidance from university and ROR leadership. Another challenge was establishing rapport with NICU site contacts through email, which can be impersonal. It was difficult to convey the importance of survey data collection. Lack of tracking for individual survey responses made it impossible to identify their source. Additionally, crafting suitable survey questions for the NICU unit was tricky due to the group's lack of prior experience in that setting.