Children's Primary Health Care Services: A Social-Cognitive Model of Sustained High Use

This study tested portions of a social-cognitive model that explained the mechanisms involved in the parent decision-making process that ultimately drive and maintain children's health care use. Eighty-seven primary caretakers of children ages 4 to 9 years completed measures of child health and behavior, parental stress and functioning, and social cognitive measures related to parenting and health care use. Primary care use data over the two-years prior to recruitment were collected from primary care providers. Regression analysis showed that social cognitive measures were significant predictors of pediatric primary care services. Specifically, parental stress interacted with general parenting self-efficacy; parents with high stress and high parenting self-efficacy were more likely to use pediatric primary care services. Self-efficacy for accessing physician assistance and parental outcome expectations for pediatric physician visits were positively related to pediatric primary care use. These social cognitive variables accounted for more variance than variables traditionally included in health care use research (i.e., child behavior, parental distress, and parent health care use). Best Subsets analysis resulted in an overall best predictive model that accounted for 29.8% of the variance in pediatric primary care use. In this model, the interaction between parental stress and general parenting self-efficacy was the best predictor of use, accounting for 11.5% of the variance in physician use. High internalizing behavior scores, higher self-efficacy for accessing physician assistance, use of medication, and more parent health care visits were associated with higher pediatric primary care use in this overall model. While acknowledging the role of child health and behavior, this study extends the literature by demonstrating the importance of considering parental perceptions of burden, confidence, and ability to help themselves and their family. Implications for health care professionals and directions for future research are discussed in light of these finding.