Early Literacy Research Library (ELRL) - Article

The Effect of Exposure to Reach Out and Read on Shared Reading Behaviors

Garbe, M. C., Bond, S. L., Boulware, C., Merrifield, C., Ramos-Hardy, T., Dunlap, M., ... & Miller-Fitzwater, A. (2023). The Effect of Exposure to Reach Out and Read on Shared Reading Behaviors. Academic Pediatrics. ,

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Publication year


study description

Secondary Data Analysis

additional materials


To assess how exposure to the Reach Out and Read (ROR) program impacts the frequency of reading and the behaviors of caregivers.



outcomes evaluated

Caregiver reading frequency and reading behaviors with children.


427 pediatric primary care clinics in North and South Carolina.


Caregivers of children aged 6 months to 5 years across 427 primary care clinics in North and South Carolina completed the "Reach Out and Read Parent Feedback Survey". Surveys completed between 2014 - 2019 were used. Caregivers who hadn't encountered Reach Out and Read (ROR) before were labeled as "new," while those who had prior exposure were labeled as "returning," allowing for a comparison of reading habits between these two groups.

sample size

N=100,656 caregivers


  • Reach Out and Read Parent Feedback Survey:  encompassing to capture the following variables:
    • Prior exposure to ROR
    • Reported frequency of reading
    • Shared reading behaviors between caregiver and child


Families that are exposed to the ROR program previously (returning caregivers) are more likely to read with their children everyday and practice positive reading behaviors such as letting child turn the pages of books, having conversations about pictures in the books, and taking the child to the library.


Exposure to the ROR program is associated with caregivers engaging in high-frequency reading and exhibiting positive reading behaviors. This finding remained consistent across all six years for which data was analyzed.


Some clinics did not provide data for all the years under examination, and as a result, it was not possible to determine completion rates, which may have varied between clinics. Additionally, given that the survey was anonymous and distributed multiple times, there is a potential that certain caregivers may have participated in the survey on multiple occasions. Some caregivers answering that this is the first time they have received a book at the doctor’s office could have received a book from a visit to a separate clinic and would have thusly been misclassified as unexposed. There is also the possibility that those truly unexposed were classified as exposed. The question of whether this was the first time the caregiver received a book does not comment on other fidelity to the ROR model.