507995

research-article2013

CPJXXX10.1177/0009922813507995Clinical PediatricsYeager Pelatti et al

Article

Methodological Review of the Quality of Reach Out and Read: Does It “Work”?

Clinical Pediatrics 2014, Vol. 53(4) 343­–350 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922813507995 cpj.sagepub.com

Christina Yeager Pelatti, PhD1, Jill M. Pentimonti, PhD2, and Laura M. Justice, PhD2

Abstract A considerable percentage of American children and adults fail to learn adequate literacy skills and read below a third grade level. Shared book reading is perhaps the single most important activity to prepare young children for success in reading. The primary objective of this manuscript was to critically review the methodological quality of Read Out and Read (ROR), a clinically based literacy program/intervention that teaches parents strategies to incorporate while sharing books with children as a method of preventing reading difficulties and academic struggles. A PubMed search was conducted. Articles that met three criteria were considered. First, the study must be clinically based and include parent contact with a pediatrician. Second, parental counseling (“anticipatory guidance”) about the importance of parent-child book reading must be included. Third, only experimental or quasi-experimental studies were included; no additional criteria were used. Published articles from any year and peer-reviewed journal were considered. Study quality was determined using a modified version of the Downs and Black (1998) checklist assessing four categories: (1) Reporting, (2) External Validity, (3) Internal Validity—Bias, and (4) Internal Validity— Confounding. We were also interested in whether quality differed based on study design, children’s age, sample size, and study outcome. Eleven studies met the inclusion criteria. The overall quality of evidence was variable across all studies; Reporting and External Validity categories were relatively strong while methodological concerns were found in the area of internal validity. Quality scores differed on the four study characteristics. Implications related to clinical practice and future studies are discussed. Keywords Reach Out and Read, methodological review, literacy

Introduction Young children’s literacy development is not only related to but also causally linked with later academic success.1,2 Children who demonstrate mastery of critical emergent literacy knowledge and skills are more successful in school than their peers, who are not afforded similar opportunities, including those raised in economically and culturally diverse environments.3-5 Academic achievement is related to success in adulthood such that those who struggle academically are more likely to drop out of school, be incarcerated, and not pursue advanced degrees.6 Shared book reading is arguably one of the most important activities that parents should include in their routines because of the potential for bolstering language development7 and emergent literacy8 to adequately prepare young children for literacy and academic success.9 Reach Out and Read (ROR) is a well-established program geared toward changing practices and beliefs around

early shared book-reading experiences of parents from economically disadvantaged backgrounds; this national initiative distributes more than 1.6 million books to more than 5000 program sites beginning at a child’s 6-month well-visit and continuing until the age of 5 (at least 10 encounters).10 Medical professionals, frequently the child’s pediatrician, provide details about the importance of reading, strategies to incorporate into shared bookreading activities (“anticipatory guidance”)11, and a “prescription” to read a new book, which establish positive early experiences surrounding literacy. 1

Towson University, Towson, Maryland, USA The Ohio State University, Columbus, OH, USA

2

Corresponding Author: Christina Yeager Pelatti, Department of Audiology, Speech-Language Pathology, and Deaf Studies, Towson University, 8000 York Road, Towson, MD 21252, USA. Email: [email protected]

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Critical Evaluation of ROR Research Studies A host of experimental (randomized controlled trials; RCTs) and quasi-experimental designs (QEDs) has evaluated ROR, and the general consensus in the literature supports that it is an effective program. Several studies have included rigorously conducted designs with causally interpretable findings. For example, Golova et al12 randomly assigned 135 Hispanic families from economically disadvantaged backgrounds to 1 of 2 groups (treatment and control). Results revealed significant differences on the 3 outcome measures, and the authors concluded that there was a substantial increase in the literacy behaviors of Hispanic parents from low-income backgrounds. This finding is based on the results of parent interviews. Perhaps, because of the self-reported nature of this form of data collection, these results are biased. Another study by Jones et al13 incorporated a prospective randomized study design to evaluate ROR for the parents of 352 children between the ages of 2 and 24 months. The authors concluded that ROR was effective given that parents who participated in the intervention condition were more likely to enjoy reading with their child. Data were not collected on children, and nearly half of the participants had dropped out of the study 2 years after enrollment (when follow-ups were conducted). Findings from other studies on ROR may be premature and not fully supported by the research design. Put simply, there are a number of methodological limitations that do not permit causal claims. For example, in a quasi-experimental study in which 79 parents of young children were interviewed based on their exposure to 1 of 3 conditions (waiting room reading, input about literacy development, book provision at wellvisits), Needlman et al14(p883) concluded that the provision of ROR “lead to positive changes in the home literacy environment.” Silverstein et al15 included a historical control group that included 95 children from a variety of multilingual populations (eg, Somali, Spanish, Vietnamese). Similar to Needlman et al,14 these authors made broad claims about ROR, such as “significant influence on parental and child attitudes toward reading and positively influences the report of home reading practices.”15(p5) Because participating parents were not randomly assigned to study conditions, such claims should be interpreted cautiously. Indeed, these findings support an association between ROR activities and home book-reading practices; however, alternative explanations cannot be eliminated given the research design. In summary, research on ROR generally supports the effectiveness of this program, including changes in

parents’ beliefs and practices (those participating in ROR “are up to four times more likely to read aloud to their children”) and children’s developmental knowledge and skills (“children served by ROR scored 3 to 6 months ahead of their non-ROR peers on vocabulary tests”).10 However, some statements may be premature and not fully supported by the quality of the extant literature on ROR. In other words, a number of study limitations are of concern, including overstated claims when experimental methods were not used, lack of standardized assessment procedures and inclusion of child direct assessments, blinding concerns, and high attrition rates.

The Current Study Over the past decade, there has been a heightened push for medical professionals to incorporate evidence-based practice, which requires pediatricians to rely on substantive and theoretical knowledge, clinical practice, and extant research literature to make decisions and promote effective practices with their patients, particularly those from economically disadvantaged backgrounds. Practitioners must pinpoint strengths and acknowledge limitations of such clinical research studies to ensure that they are providing their patients with the highest quality of care. However, there is a potential disconnect between the extant literature on ROR and the broad claims about its effectiveness. The absence of a published systematic review requires pediatricians to compile research findings on their own, a task that may be difficult with rigorous schedules and time constraints. Thus, the purpose of the present manuscript is to critically evaluate the methodological quality of evidence of the ROR program.

Method The methodology includes 2 broad components: (a) literature search and article selection and (b) analysis of the quality of ROR studies, both of which are discussed in detail below.

Literature Search and Article Selection The primary goal of this initial step was to identify the entire body of research studies that included procedures related to ROR. A thorough PubMed search was conducted; the following search terms were included: clinic-based literacy program, Reach Out and Read, and anticipatory guidance. Published articles from any year and peer-reviewed journal were considered. Only the articles that met the following 3 criteria were considered

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Yeager Pelatti et al for inclusion in the present article. First, the study must be clinically based and include parent contact in the waiting or examination room with a pediatrician. Second, some form of parental counseling or “anticipatory guidance” related to the importance of parent–child book reading must be included. Third, only those studies that were RCTs or QEDs were included in the present review; other research designs (eg, qualitative studies) were not considered. Interrater reliability was 100%, which highlights that the previously described process was reliable. A total of 11 articles met the inclusion criteria. After the authors identified articles that met this criteria, study characteristics were coded for each study. These included the following: (a) research design (RCT, QED), (b) age of children, (c) journal and publication year, (d) study details (number of subjects, participant characteristics, main study finding), and (e) outcome measures.

Determination of Study Quality A modified version of the Downs and Black16 checklist, a detailed measure used for experimental and quasiexperimental designs, was used to determine study quality. The original measure included 27 questions; however, 2 questions were omitted in this review, which is consistent with the procedures used by Justice et al.17 Quality was assessed in 4 categories: (a) Reporting, (b) External validity, (c) Internal Validity–Bias, and (d) Internal Validity–Confounding (Selection Bias). More specific statements, which were scored as yes (1) or no (0), were included within each general category; a composite score was determined by summing total responses across all 25 questions. This measure has high reliability and validity.16,18 All 11 articles were independently scored by 2 reviewers, who were not blind to any article details. Interrater agreement for all articles was 96%. Differences were discussed and reconciled to 100%.

Table 1.  Overview of Articles.a Description Research design   Randomized controlled trial   Quasi-experimental design Children’s age (months)  150). Although sample size is an important consideration when designing research studies, other factors, including random assignment, fidelity, blinding, and attrition, should be thoughtfully considered to ensure that the study design is of the highest quality and has the potential to make an impact on the field. Most of the studies in the present article included book reading frequency as an outcome measure while few assessed children’s development. Of the 4 studies that assessed children’s language skills, only 2 studies did so via direct measures and only included the language domain of vocabulary. There is a need for future studies to include both direct and indirect measures of children’s language and emergent literacy. Although vocabulary development is an important component of children’s academic success, this specific domain of language tends to be delayed for children from diverse

economic, cultural, and linguistic backgrounds.21,22 Given the myriad of literacy intervention studies, measures of emergent literacy, such as print knowledge and phonological awareness, should also be included in future studies incorporating ROR. To the best of our knowledge, none of the ROR studies followed young children after school entry. Thus, it remains unclear if positive outcomes, based on participation in ROR, are maintained in kindergarten and beyond. This is particularly important because ROR’s primary goal is to adequately prepare young children for academic success. In summary, while medical professionals have the potential to provide parents with critical information about key features of book reading, this methodological review highlights that some of the articles related to ROR should be interpreted cautiously given the variability of quality and study design concerns. As we have highlighted, additional research studies that incorporate research designs are recommended to ensure that young children are provided with the highest quality of prevention so that they are adequately prepared for academic success. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

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follow-up of low-income children in public schools. JAMA. 2001;285:2339-2347. 7. Scarborough HS, Dobrich W. On the efficacy of reading to preschoolers. Dev Rev. 1994;14:245-302. 8. Justice LM, Ezell HK. Use of storybook reading to increase print awareness in at-risk children. Am J Speech Lang Pathol. 2002;11:17-29. 9. Snow CE, Burns MS, Griffin P. Preventing Reading Difficulties in Young Children. Washington, DC: National Academy Press; 1998. 10. Where great stories begin. Reach Out and Read Web site. http://www.reachoutandread.org. Published 2013. Accessed May 29, 2013. 11. Diener M, Wright C, Julian J, Byington C. A pediatric literacy education program for low socioeconomic, culturally diverse families. J Res Child Educ. 2003;18: 149-159. 12. Golova N, Alario AJ, Vivier PM, Rodriguez M, High PC. Literacy promotion for Hispanic families in a primary care setting: a randomized, controlled trial. Pediatrics. 1999;103:993-997. 13. Jones VF, Franco SM, Metcalf SC, Popp R, Staggs S, Thomas AE. The value of book distribution in a clinicbased literacy intervention program. Clin Pediatr. 2000;39:535-541. 14. Needlman R, Fried LE, Morley DS, Taylor S, Zuckerman B. Clinic-based intervention to promote literacy: a pilot study. Am J Dis Child. 1991;145:881-884.

15. Silverstein M, Iverson L, Lozano P. An English-language clinic-based literacy program is effective for a multilingual population. Pediatrics. 2002;109:1-6. 16. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomised studies of health care interventions. BMJ. 1998;52:337. 17. Justice LM, Nye C, Schwarz J, McGinty A, Rivera A. Methodological quality of intervention research in speechlanguage pathology: analysis of 10 years of group-design studies. Evid Based Commun Assess Interv. 2008;2:46-59. 18. Deeks JJ, Dinnes J, D’Amico R, et al; International Stroke Trial Collaborative Group; European Carotid Surgery Trial Collaborative Group. Evaluating non-randomised intervention studies. Health Technol Assess. 2003;7:1-173. 19. High PC, LaGasse L, Becker S, Ahlgren I, Gardner A. Literacy promotion in primary care pediatrics: can we make a difference? Pediatrics. 2000;105:927-934. 20. Raudebush SW. Learning from attempts to improve schooling: the contribution of methodological diversity. Educ Res. 2005;34:25-31. 21. Washington JA, Craig HK. Performance of low-income African American preschool and kindergarten children on the Peabody Picture Vocabulary Test–Revised. Lang Speech Hear Serv Sch. 1992;23:329-333. 22. Whitehurst GJ, Arnold DS, Epstein JN, Angell AL, Smith M, Fischel JE. A picture book reading intervention in day care and home for children from low-income families. Dev Psychol. 1994;30:679-689.

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Methodological review of the quality of reach out and read: does it "work"?

A considerable percentage of American children and adults fail to learn adequate literacy skills and read below a third grade level. Shared book readi...
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