Link to full text: https://publications.aap.org/pediatrics/article/113/5/1248/66721/More-Evidence-for-Reach-Out-and-Read-A-Home-Based
Access: Institutional Access
study descriptionCross-sectional study.
core topic(s)Reach Out and Read (ROR)
Exposures, Outcomes, OtherPlay
metric(s)Home Observation for Measurement of the Environment (HOME)
Slosson Oral Reading Test (SORT)
objectivesThe objective of this study was to determine the relationship between the frequency of ROR encounters that a family receives during well-child visits and a child’s home literacy profile, while accounting for important confounders, such as the quality of the home environment.
exposureReach Out and Read (ROR).
outcomes evaluatedHome literacy environment.
settingYale-New Haven Hospital Primary Care Center.
methodsA cross-sectional study was conducted of 137 children (aged 18-30 months) who received pediatric well-child care at the Yale-New Haven Hospital Primary Care Center. The number of ROR encounters that the family received was determined though parent interview, direct observation, and a review of the medical record. After a brief waiting room interview, a home visit was conducted. An assessment of the child’s home literacy environment was completed on the basis of 10 variables that were obtained from parent report and direct observation within the home. These variables were summed to form a Child Home Literacy Index. The Home Observation for Measurement of the Environment, a standardized measure of the nurturing quality of the home environment, was also administered. Hierarchical linear regression was conducted to determine the significance of ROR on a child’s home literacy environment.
sample sizen=137 (children 18-30 months)
Measure of Home Literacy Environment: Home Observation for Measurement of the Environment (HOME) with questions about:
- primary caregiver’s emotional and verbal responsivity to the child.
- avoidance of restriction and punishment.
- organization of the environment.
- provision of appropriate play material for the child.
- primary caregiver’s involvement with the child.
- opportunities for variety in daily stimulation activities at home.
Measure of Adult Literacy: Slosson Oral Reading Test-Revised (SORT-R).
Measure of WCV Compliance: review of medical record.
Measure of Child Home Literacy Index (CHLI) Score: variables summed to generate score; higher total score indicates a greater presence of literacy-promoting behaviors in a child’s home environment.
resultsA total of 100 families completed both a waiting room interview and a home visit. Families received between 0 and 6 books in the ROR program. A total of 93% of families reported reading to their children, but only 35% of parents identified reading as a favorite activity of their child and 45% of parents reported that this was a favorite joint activity. Hierarchical linear regression demonstrated that increasing frequency of ROR encounters contributed a small but significant portion of the variance explaining a child’s home literacy profile (5%), with this model accounting for a total of 19% of the variance.
conclusionsA modest literacy intervention, such as ROR, can have a significant impact on a child’s home literacy environment.
limitationsFirst, this was a cross-sectional study, which did not allow us to examine baseline literacy behaviors before families had experienced any ROR encounters and then assess changes in literacy behaviors over time. Second, this study did not have a control group that did not receive the intervention. We were able to assess a “dose response” to an increasing number of ROR encounters on a child’s literacy environment, but we were not able to do this through a randomized, controlled trial. Our moderate sample size did not allow us to subdivide our sample and compare groups because only 22 families had received 0 or 1 book. Third, the attrition rate in this study was moderate. Of the 137 families who consented to participate in the study, only 100 completed home visits. This represents an attrition rate of 27%. Families who completed home visits and families who did not complete home visits were similar except for higher employment rates in the 37 families who did not complete home visits (67% vs 55%). This degree of attrition is not surprising when one considers that a home visit was required, with which many families may be uncomfortable.