A Mixed-Methods Investigation Examining Site-Level Variation in Reach Out and Read Implementation
by Darlene H. Forbes MD, Department of Pediatrics, Central Jersey Medical Center (DH Forbes), Perth Amboy, NJ
(In collaboration with Manuel E. Jimenez MD, MS;Jennifer R. Hemler PhD;Nila Uthirasamy BS;Alicja Bator MPH;Michael Lucas MD;Usha Ramachandran MD;Benjamin F. Crabtree PhD;Thomas I. Mackie PhD, MPH)
Reach Out and Read (ROR) is an evidence-based early childhood intervention that has been implemented at scale, yet description of ROR implementation is inconsistent. This study engages implementation science to examine ROR delivery and site-level variation.
As part of an ongoing clinical trial, we conducted a mixed-methods study in 3 community health centers (CHCs) that serve low-income Latino families. We integrated quantitative parent survey data, qualitative data from monthly key informant interviews with ROR site leaders over 1 year, and in-depth interviews with 18 additional clinicians. At enrollment, parents reported whether they received a children’s book, guidance on reading, and modeling from clinicians. We analyzed quantitative data using descriptive statistics, and qualitative data iteratively engaging emergent and a priori codes drawn from the Template for Intervention Description and Replication Checklist.
Three hundred Latino parents (mean age: 31; 75% ≤HS education) completed surveys. The mean child age was 8 months. Overall, most parents reported receiving a book (84%) and guidance (73%), but fewer experienced modeling (23%). Components parents received varied across CHCs. Two themes emerged to explain the variation observed: 1) differences in the perceived purpose of shared reading and book delivery aligned with variation in implementation, and 2) site-level barriers affected what components were implemented.
Because of substantive variation in ROR implementation across sites, systematic descriptions using established frameworks and corresponding measurements to characterize ROR implementation may enhance our understanding of mechanisms underlying ROR’s effects, which clinicians and policymakers can use to maximize ROR’s impact.
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