| Question | Answers | Source | Source Link | Dates Used | |
|---|---|---|---|---|---|
| 1 | Who do you turn to for advice and support about your child's physical health and emotional well-being? Select all that apply. | • Pediatrician / doctor • Childcare provider / teacher • Home visitor • Faith leader • My friends / family • Others in my town / city / community (e.g., word of mouth, acquaintances, colleagues, neighbors) • I search online (i.e., Google) • An online community (e.g., a blog, Facebook group) • Not Listed (please specify) | NA | 03/09/2023-03/15/2023 | |
| 2 | Thinking about recent appointments with your child(ren)’s doctor, did they ask you if your household is having any challenges paying for basic needs (e.g., housing, utilities)? | • Yes • No • I don't know | NA | 03/09/2023-03/15/2023 | |
| 3 | Thinking about recent appointments with your child(ren)’s doctor, did they ask you if your household is having any challenges getting enough food for the family? | • Yes • No • I don't know | NA | 03/09/2023-03/15/2023 | |
| 4 | If your child(ren)'s doctor told you that you were eligible for a food program like WIC or SNAP (formerly known as food stamps), how would that influence your decision to sign up for that program? | • I would be less likely to sign up • It would not influence my decision • I would be more likely to sign up | NA | 03/09/2023-03/15/2023 | |
| 5 | Please rate your level of agreement with this statement: I trust my child(ren)'s doctor. | • Strongly disagree • Disagree • Neutral • Agree • Strongly agree | NA | 03/09/2023-03/15/2023 |