Early Literacy Research Library (ELRL) - Article

Us and them: Individual and group perceptions and attitudes about Reach Out and Read implementation in one pediatric clinic

Stone, J. K., & Erickson, K. A. (2023). Us and them: Individual and group perceptions and attitudes about Reach Out and Read implementation in one pediatric clinic. Journal of Early Childhood Literacy, 14687984231212722.,

Access: FREE/Open Access

Download the full text: Stone_2023

Publication year


study description

Qualitative study

core topic(s)

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

Population Characteristics

Medical Providers , Urban

Exposures, Outcomes, Other

Anticipatory Guidance , Community , Implementation and Evaluation , Parent-Child Relationships/Interactions , Reading Frequency


The primary objective of this study was to explore clinic group culture surrounding Reach Out and Read (ROR) at a pediatric clinic recognized as successful in ROR implementation.



outcomes evaluated

Analyzing clinic group culture through semi-structured interviews regarding staff perceptions and feelings surrounding ROR


Pediatric Primary Care


In examining clinic group culture, we worked alongside a ROR regional representative and a pediatrician spearheading effective ROR implementation. Together, we developed a semi-structured interview protocol to delve into staff perceptions and sentiments regarding ROR. Subsequently, we conducted these interviews with twelve non-physician staff members within the pediatrician's clinic.

sample size

12 clinic staff members


A two-phase grounded theory analysis revealed an ingroup/outgroup relationship that created two distinct cultural groups related to ROR. Participants described themselves as ingroup members and the patients receiving ROR as outgroup members. The ingroup included community organizations, doctors, and study participants, working together to give books and information to parents and medical students, who made up the outgroup


This study reveals how book-gifting initiatives like Reach Out and Read (ROR) can unintentionally create 'us and them' dynamics. Examining non-physician staff perspectives in a pediatric clinic, it underscores cultural nuances impacting ROR implementation. Recognizing these dynamics is crucial to prevent discrimination as these initiatives expand. As ROR advocates aim for an "equity lens," acknowledging literacy advocacy complexities becomes vital, aligning with calls to explore structural inequities through diverse methods.


This study has several limitations. Firstly, the data were collected from a single site. Secondly, information was exclusively obtained through individual interviews with 12 volunteer participants, likely motivated by their interest in ROR. Thirdly, member checks involved research partners instead of individual participants. Fourthly, recruitment materials positively highlighted ROR, potentially affecting participants' inclination to associate with the program and possibly discouraging staff not involved in ROR from participating. Additionally, each interview emphasized the characteristics of ROR, and the blend of celebratory language and the emphasized importance of ROR factors may have introduced a desirability bias influencing participants' interview responses (Brewer and Gardner, 1996).