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Jimenez ME, Hemler JR, Uthirasamy N, Bator A, Forbes DH, Lucas M, Ramachandran U, Crabtree BF, Mackie TI. A Mixed-Methods Investigation Examining Site-Level Variation in Reach Out and Read Implementation. Acad Pediatr 2023; 23:913-921. [PMID: 36496152 PMCID: PMC10244479 DOI: 10.1016/j.acap.2022.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION Because of substantive variation in ROR implementation across sites, systematic descriptions using established frameworks and corresponding measurement 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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Affiliation(s)
- Manuel E Jimenez
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School (ME Jimenez and U Ramachandran), New Brunswick, NJ; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School (ME Jimenez, JR Hemler, N Uthirasamy, A Bator, and BF Crabtree), New Brunswick, NJ; Children's Specialized Hospital (ME Jimenez), New Brunswick, NJ.
| | - Jennifer R Hemler
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School (ME Jimenez, JR Hemler, N Uthirasamy, A Bator, and BF Crabtree), New Brunswick, NJ
| | - Nila Uthirasamy
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School (ME Jimenez, JR Hemler, N Uthirasamy, A Bator, and BF Crabtree), New Brunswick, NJ
| | - Alicja Bator
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School (ME Jimenez, JR Hemler, N Uthirasamy, A Bator, and BF Crabtree), New Brunswick, NJ
| | - Darlene H Forbes
- Department of Pediatrics, Jewish Renaissance Medical Center (DH Forbes), Perth Amboy, NJ
| | - Michael Lucas
- Saint Peters University Hospital Pediatric Faculty Group (M Lucas), New Brunswick, NJ
| | - Usha Ramachandran
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School (ME Jimenez and U Ramachandran), New Brunswick, NJ; Department of Pediatrics, Eric B. Chandler Health Center (U Ramachandran), New Brunswick, NJ
| | - Benjamin F Crabtree
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School (ME Jimenez, JR Hemler, N Uthirasamy, A Bator, and BF Crabtree), New Brunswick, NJ
| | - Thomas I Mackie
- Department of Health Policy and Management, SUNY Downstate Health Sciences University (TI Mackie), Brooklyn, NY
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