Thank you for taking part in this survey, the purpose of which is to help us better understand your current experiences in taking your child for routine visits with his or her child health provider (or pediatrician).
 
As a parent/caregiver, you play an important role in understanding your child, his/her health and development, and areas where your family or your child may benefit from additional support. We are currently exploring possible ways to maximize your visit with the child health provider, such as by developing new questionnaires, visit planners, or by using technology to better support the visit. The results of this survey will allow us to understand what parents want/need in this area and directly inform future work.

Your individual response to the survey will not be shared. Thank you for taking the time to share your thoughts with us.  

Question Title

* 1. Are you 18 years or older or emancipated?

Question Title

* 3. Do you have a child between the ages of 0 and 8?

Question Title

* 4. How many children between the ages of 0 and 8 currently live with you at least half the year?

Question Title

* 5. What is the primary language spoken in the home?

Question Title

* 6. What is your race? (Select one or more boxes)

Question Title

* 7. Are you Hispanic or Latino?

Question Title

* 8. What is your age?

Question Title

* 9. How would you characterize the town/city in which you live?

Question Title

* 10. What is the highest grade or level of school you completed?

Question Title

* 11. Think about the youngest of the children living with you: how old is that child (in years?)

Question Title

* 12. During the past 12 months, how many times did this child see a doctor, nurse, or other healthcare provider for a well-child check-up (not a visit that was to address a specific concern or illness)?

Question Title

* 13. During the most recent well-child check-up that you remember, please rate how prepared you felt to discuss topics with your child’s provider:

Question Title

* 14. If you rated yourself very or somewhat prepared, please share any reasons why you felt prepared for your visit:

Question Title

* 15. If you rated yourself somewhat or very unprepared, please share any reasons why you felt unprepared for your visit:

Question Title

* 16. Do you have sufficient time to the discuss what you would like to talk about during your child’s well-child check up?

Question Title

* 17. Would you be interested in a planning tool that you would complete before your check-up appointment that could help your pediatrician know what things you would like to talk about during your visit?

Question Title

* 18. What is the format that you would want to use to complete the planning tool? (Check all that apply)

Question Title

* 19. During the most recent well-child check-up that you remember, please select any topics you discussed with your child’s provider:

Question Title

* 20. What do you most enjoy about your visits with your child’s health provider?

Question Title

* 21. What do you wish you could get from your visits with your child’s health provider that you don’t currently get?

Question Title

* 22. What motivates you to be excited about and participate in your child’s well-child check-ups (check all that apply):

Question Title

* 23. For the following screening topics, please rate how helpful you think it would be to review this type of information with your child’s health care provider as part of your child’s regular check-up:

Scale for each that assesses helpfulness:

  Very Helpful Somewhat Helpful Somewhat Unhelpful Very Unhelpful
How your child is doing with specific activities like talking, playing, and engaging in physical activities
How your child behaves, such as how your child handles new situations, how much he/she is sleeping, crying, and how well he/she pays attention
How things are going more generally for your family, including things like whether there is enough food at home for the family, whether drugs or alcohol are a problem in your family, how well the family is getting along

Question Title

* 24. Your child’s health provider may already or may in the future ask you to complete questionnaires about some of the topics above. In filling out this information to support your child’s well-visit check-up, what format would you most prefer?

Question Title

* 25. How much time would you be willing to spend in completing these questionnaires before the visit?

Question Title

* 26. If you could receive and take with you results from the questionnaires you complete, how likely do you think you would be to use information later on at home?

Question Title

* 27. If you answered "not likely", why not?

Question Title

* 28. If you want to share private or difficult information with your provider so that your family could receive help and support, would you be more likely to share that information in an electronic format (such as app, online form) or in-person during the visit?

Question Title

* 29. In the past 12 months have you discussed relational health with your child’s health provider (i.e. issues with you and your child’s relationship, tantrums, behavior problems)?

Question Title

* 30. On the scale below, please indicate how much you value parenting advice provided by your doctor

Do not value at all Sometimes value Highly  value
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 31. If your provider could give you important tips on how to strengthen your connection with your child, how interested would you be in that feedback?

Question Title

* 32. Sometimes during a well-visit check-up, providers might know about a resource or service that could be helpful for families, such as a diaper bank or child play group. If your child’s provider wanted to connect your family to services, how would you prefer that take place?

Question Title

* 33. If other, please explain:

Question Title

* 34. When you are not at your child's doctor's office, where do you find information and resources related to your child's developmental, social, and emotional health? Check all that apply:

Question Title

* 35. Right now, how frequently do you rely on technology, or things such as apps, social media, websites, etc. for information about health or healthcare?

Question Title

* 36. Right now, do you think your child’s health care providers should be using more things such as apps, texting, or websites, less of these things, or about the same amount of technology in the office setting?

Question Title

* 37. If you answered "more technology" or "less technology" above, please tell us more:

T