CONNECT Survey

In collaboration with parents* and parent leaders from a wide variety of communities across the US, Reach Out and Read has developed and validated the CONNECT survey, which measures the parent-clinician relationship during routine pediatric visits. Use of this survey in clinics has strongly indicated that Reach Out and Read improves the parent-clinician relationship.

*A note on terminology: At Reach Out and Read, we appreciate and understand that children can fall under the care of any number of adults: parents, grandparents, extended family, foster parents, and many more. Within this webpage, we will use the term “parent” to mean any adult figure responsible for the consistent care and wellbeing of the child.

  • What is the CONNECT Survey?
    Co-created by parents for parents, the CONNECT Survey was developed in partnership with Reach Out and Read and the Institute for Child Success (ICS) to gain insights into the parent/caregiver relationship during routine pediatric visits. Based on input from what matters most to parents, the aim of the CONNECT study is to accurately reflect and measure what parents value within a well-child visit.
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  • Why did we develop the CONNECT Survey?
    • In the initial phase of this project, Reach Out and Read convened a meeting with parent leaders from across the US with the goal of learning how best to improve delivery of the model in routine pediatric visits.
      What we learned from parents in the meeting is this: the relationship between the parent and the clinician plays a critical role in whether or not parents follow the advice given by their clinician.
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Patient Experience and the Parent-Clinician Relationship

Patient experience is an important and well-researched part of medical care. Research has shown that patients who are satisfied with their visits are more likely to adhere to the advice provided by the clinician, which can have long-term impacts on their health and well-being7. Patient experience also increases retention and the likelihood of continuity of care3. According to the American Academy of Pediatrics, patient experience is particularly critical in pediatric care.

“In pediatric healthcare, the importance of patient experience is magnified due to the unique vulnerabilities and developmental needs of children. Ensuring a positive patient experience in pediatric settings not only fosters better health outcomes but also builds trust and engagement with healthcare systems that can last a lifetime7.”

Surveys currently used in the field often measure patient experience or satisfaction. While these surveys include questions about communication, trust, and safety, they rarely focus on what parents tell us matters most: the parent-clinician relationship. This process with parents and parent leaders helped us realize that the parent-clinician relationship may be just as, if not more, predictive of parent adherence to clinical advice in pediatric settings.

Additionally, most of the prominent patient experience surveys used in pediatric clinics have not been validated for use within these settings. Even fewer of these surveys were developed in conjunction with parent or patient input.

With this in mind, Reach Out and Read set out to develop a parent-clinician relationship survey created for parents by parents.

How did we develop the CONNECT Survey?

For about one year, Reach Out and Read worked with eight parent leaders and 35 parents to develop and refine the CONNECT Survey. This process began with a series of Empathy Interviews, where parent leaders had one-on-one conversations with parents across five states: Florida, California, New Mexico, Pennsylvania, and New Jersey. Interviews involved families with children aged 0–5 years, representing a diverse demographic background (43% Black/African American, 20% White; 94% mothers, 6% fathers; 54% on Medicaid, 26% on private insurance).

Empathy Interviews use open-ended questions to elicit stories about specific experiences that help uncover needs. These one-hour interviews were conducted by the parent leaders and with another parent transcribing the conversation (with consent from the parent being interviewed).

Research leads at ICS conducted a thematic analysis on the interview notes from the Empathy Interviews, which were then reviewed by parent leaders and parents for accuracy.

Prominent themes included:

  • Being actively listened to and feeling genuinely attended to.
  • Receiving clear communication about their child’s health.
  • Being respected, valued, and treated without judgment.
  • Demonstration of kindness, empathy, and genuine care from clinicians.
  • Being engaged in shared decision-making.
  • Accessibility to clinicians and health information.
  • Positive interactions with office staff and a welcoming clinic environment.

Once the themes from the parent conversations were identified and developed into approximately 50 survey questions by research leads, Reach Out and Read and ICS then utilized the Delphi Method with parent leaders to fine-tune the survey.

The Delphi Method is an established qualitative research method to refine a survey using experts in the field. Through this method, parent leaders engaged in three iterative rounds of review of the survey, narrowing down the questions to the final 13.

Distribution of Parent Participants in Empathy Interviews

  • How did we validate the survey?
    Survey validation, the process through which survey questions have been proven to yield consistent, accurate results from the intended population, is critical in determining whether the data gathered correctly reflects the experiences of the patient.
    The validation of the survey was conducted using two distinct datasets:
    1. A primary dataset collected from pediatric clinics via the Mid-Atlantic Reach Out and Read network used for psychometric validation.
    2. A secondary dataset collected from Florida Reach Out and Read clinics used to assess test-retest reliability.
    Within the Mid-Atlantic, the CONNECT survey was simply distributed to parents in 131 clinics immediately after their well-child visit. Just over 10,000 surveys were collected and resulted in a sample of nearly 3,000 surveys that reflected the racial and ethnic diversity of the families served by Reach Out and Read on a national level.
    In the Florida Reach Out and Read Affiliate, parents were asked to complete the CONNECT survey twice — once just after their child’s well-child visit and then again 5–7 days later. Responses were matched across time points using unique identifiers, resulting in a final analytic sample of 60 matched parent responses.
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  • Survey Findings
    Results from our validation study provide strong evidence of the CONNECT Survey’s reliability, validity, and practical utility in measuring parent-clinician relationship quality during pediatric well-child visits.
    • Reliability: The survey demonstrated excellent internal consistency with inter-item correlations. These findings confirm that the items cohesively measure a single underlying construct — relational quality. However, the strength of these correlations suggests potential redundancy across some items, which could be considered in future refinements.
    • Construct Validity: Established evidence confirms that the CONNECT Survey measures a single underlying construct: the caregiver–provider relationship quality.
    • Convergent Validity: Demonstrated through statistically significant correlations between the CONNECT Survey and items from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Press Ganey surveys, including caregiver-reported respect, communication, and likelihood to recommend.
    • Concurrent Validity: Supported by findings from ordinal logistic regression models.
      • Parents from clinics delivering Reach Out and Read with high-quality were 46% more likely to report a higher average score than parents from other clinics. This strongly indicates that the Reach Out and Read model improves the parent-clinician relationship.
    • Measurement Invariance: Analyses indicate significant subgroup differences across race/ethnicity, insurance status, and child age. These findings suggest that the CONNECT Survey is sensitive to disparities in caregiver/provider relationships and makes it a valuable tool for quality monitoring and equity-oriented improvement efforts.
    If you would like more information on this process, you can download the full report here.
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  • What’s Next?
    Although our findings provide evidence that the CONNECT Survey captures meaningful variation in caregiver-reported experiences and can help identify relational strengths and gaps across diverse populations, we want to make improvements.
    To learn from even more families, we are looking to test small changes to the survey in different clinics and populations across the US and will continue to work with parents and caregivers to improve the survey in a way that reflects the lived experiences of families in pediatric care clinics.
    1. Confirm our findings that Reach Out and Read improves the parent-clinician relationship
    2. Improve the usability of our survey to detect changes in the parent-clinician relationship
    3. Identify Reach Out and Read support processes that improve quality and the parent-clinician relationship
    4. Evaluate the impact of Reach Out and Read on associated outcomes such as well-child visit compliance and adherence to guidance
    5. Establish a Practice-Based Research Network using quality improvement (QI) processes to improve the parent-clinician relationship
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  • References – PW training
    1. Institute of Medicine. 2001. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press. https://doi.org/10.17226/10027
    2. Berwick, D.M, Nolan, T.W., & Whittington, J. (2008). The Triple Aim: Care, Health, and Cost. Health Affairs, 27 (3) https://doi.org/10.1377/hlthaff.27.3.759
    3. Committee on Hospital Care and Institute for Patient- and Family-Centered Care. (2012). Patient- and Family-Centered Care and the Pediatrician’s Role Pediatrics (2012) 129 (2): 394–404. https://doi.org/10.1542/peds.2011-3084
    4. Vaughn, N., and Snively, E. Relias Blog (2024) Maximizing Healthcare Reimbursement Through Higher Patient Satisfaction Scores https://www.relias.com/blog/healthcare-reimbursement-patient-satisfaction-scores
    5. Medicaid Innovation Accelerator Program Quality Measurement Learning Series: Considerations for Measuring Person and Family Engagement and Activation in Medicaid. https://www.medicaid.gov/state-resource-center/innovation-accelerator-program/iap-downloads/functional-areas/person-family-engagement.pdf
    6. Toomey SL, Zaslavsky AM, Elliott MN, Gallagher PM, Fowler FJ Jr, Klein DJ, Shulman S, Ratner J, McGovern C, LeBlanc JL, Schuster MA. The Development of a Pediatric Inpatient Experience of Care Measure: Child HCAHPS. Pediatrics. 2015 Aug;136(2):360-9. doi: 10.1542/peds.2015-0966. Epub 2015 Jul 20. PMID: 26195542; PMCID: PMC5036167.
    7. American Academy of Family Physicians. (2022). How to improve patient experience in your practice. Family Practice Management, 29(2), 27-32. Retrieved from https://www.aafp.org/pubs/fpm/issues/2022/0300/p27.html
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