Early Literacy Research Library (ELRL) - Article

The Value of Book Distribution in A Clinic-Based Literacy Intervention Program

Jones, V.F., Franco, S.M., Metcalf, S.C., Popp, R., Staggs, S., Thomas, A.E. (2000) The Value of Book Distribution in a Clinic-Based Literacy Intervention Program. Clinical Pediatrics (Phila), 39(9), 535-541.,

Access: Institutional Access

Publication year


study description

Prospective, controlled study.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Infant/Newborn , Medical Trainees

Exposures, Outcomes, Other

Anticipatory Guidance , Parent Knowledge, Attitudes, and Beliefs , Parent-Provider Relationships/Interactions , Provider Knowledge, Attitudes, and Beliefs


The purpose of this study was to determine whether anticipatory guidance at well-child visits (WCV) that included early literacy development and the provision of books by the examining physician changed family literacy practices.


Reach Out and Read (ROR).

outcomes evaluated

Family literacy orientation and parent-provider communication.


Inner-city pediatric clinic that serves as the continuity practice site for pediatric and pediatric/internal medicine residents of the University of Louisville.


There were 352 children (181 treatment: 171 control), aged 2 to 24 months, enrolled in this prospective, controlled study. The health care providers underwent training on literacy and on how to incorporate this information during WCV. Anticipatory guidance on safety, development, and early literacy was given to all parents. Additionally, the treatment group received an age-appropriate book at each WCV. There were 1,263 visits made (686 treatment, 577 control). Questionnaires were completed by parents on physician helpfulness and by physicians on parental receptiveness.

sample size

n=352 (total children); n=181 (treatment); n=171 (control); n=1,263 (total visits); n=686 (treatment); n=577 (control)


Measures of Parent-Provider Communication:

    • Parent perception of physician helpfulness: questionnaire on how helpful the doctor was during the WCV and whether the physician provided guidance on safety, development, or how to use a book.
    • Physician perception of parent receptiveness: receptivity ratings 1-5 and written observations of mother and child during the reading demonstration and after the book was given.
    • Measure of Family Literacy Orientation: questions about reading, safety, and development, parental beliefs and knowledge about literacy development, and evidence of literacy practices in the home.


Parental ratings on physician helpfulness were higher in the treatment group than in the control group (p<0.05). Physician's rating of parental receptiveness was also higher in the treatment group than in the control group (p<0.05). Two years after enrollment, mother-child pairs who received guidance and a book were two times more likely to report enjoyment in reading together than the controls who received guidance but no book.


We conclude that anticipatory guidance that included early literacy development and distribution of books at WCV resulted in increased family literacy orientation, parental receptiveness, and perception of physician helpfulness.


Assignment of participants to either treatment or control groups on alternate days achieved a representation of the clinic population in each group but the method was not a true randomization. The use of multiple physician participants with varying manner of reading demonstration and presentation of the literacy information may have affected the parent's perception of the usefulness of reading as an important source of early learning. Additionally, the graduate students who did parental interviews 24 months after enrollment were not blinded to the study question and thus potentially may have influenced the content of their report. The most limiting factor in our study was the small number of families available for interview at 24 months after study entry. This factor alone may have contributed to the absence of significant differences between the two groups.