P2.144: Validation of a Reach Out and Read Survey on the Relationship Between Pediatric Primary Clinicians and Parents/Caregivers of Young Children

Background: The relationship between clinicians and parents/caregivers of young children is critical in the effectiveness of pediatric primary care and has significant influences on health outcomes. Reach Out and Read co-developed with parents of young children a survey of the parent/caregiver-clinician relationship in pediatric primary care that represented their concepts and language. The survey was then validated as a tool to improve relationships between pediatric primary clinicians and parents/caregivers of young children.

Methods: The Reach Out and Read research team, including parents, research scientists and clinicians engaged with 35 parents representing a variety of demographics in a process of empathy interviews and the Delphi Method to develop a parent/caregiver-clinician relationship survey. The survey was completed by families following newborn to 5-year-old well child visits at 131clinics that deliver Reach Out and Read. At the end of data collection, we received 9825 surveys.
Validation procedures included exploratory factor analysis and assessments of internal consistency at both overall and subgroup levels using Cronbach’s alpha. To evaluate potential bias across key demographic variables, we conducted rank-sum tests, Kruskal-Wallis tests, and logistic regression analyses controlling for relevant covariates. Convergent validity was examined through associations with the “likelihood to recommend” item from the Press Ganey survey, two CAHPS Health Plan Survey items addressing communication and respect, and the Reach Out and Read program fidelity measure.

Results: Empathy interviews with parents and a parent-inclusive Delphi process resulted in a 13-item survey representing 3 core themes (see Table 1). Together, the empathy interviews and Delphi process established the survey’s content validity.
The validation findings confirmed the survey’s reliability and validity. Psychometric analyses demonstrated strong internal consistency (Cronbach’s alpha > .90). Exploratory factor analysis (EFA) supported a one-factor model. Convergent validity was assessed via correlations that provided alignment with established indicators of relational quality. Additional convergent validity was demonstrated through comparisons by Reach Out and Read fidelity classification: patients at higher-quality sites were 46% more likely to report higher relationship scores and 45% more likely to report higher Press Ganey “likelihood to recommend” scores. Concurrent validity was supported by findings that families with higher provider continuity were 92% more likely to report higher average relationship scores, indicating the survey captures meaningful variation in relational care experiences.
Differential item functioning (DIF) analysis examined potential bias across race/ethnicity, insurance type, and child age. A summary of DIF results is presented in Table 2.

Conclusion: The Reach Out and Read parent/caregiver-clinician relationship survey is suitable for use as a tool to improve relationships between pediatric primary clinicians and parents/caregivers of young children.