Children's primary health care services: A social-cognitive model of sustained high use.

Objective To test social-cognitive influences on parent decision-making processes related to children’s health care use. Methods Eighty-seven primary caretakers of children ages 4 to 9 years completed measures of child health and behavior, parent functioning, and social-cognitive factors related to parenting and health care use. Primary care use was obtained from the children’s primary care physician(s) for the 2 years prior to recruitment. Results Social-cognitive variables accounted for 13.2 % of the variance in primary health care use, above and beyond the influence of child health status and psychosocial variables. The best predictive model, accounting for 29.8 % of the variance in primary care use, included the interaction be-tween parental stress and self-efficacy to cope with parenting demands, child behavior prob-lems, self-efficacy for accessing physician assistance, medication use, and parent health care use. Conclusions Results documented the relationship between self-efficacy and parent stress in decision making about pediatric primary care use. Social-cognitive theory provides a new perspective for evaluating factors that influence health care use. Key words utilization; health care; primary care; children. Significant variability in the use of primary care services by