Title page for ETD etd-04262001-215204

Type of Document Dissertation
Author Janicke, David Michael
URN etd-04262001-215204
Title Children's Primary Health Care Services: A Social-Cognitive Model of Sustained High Use
Degree PhD
Department Psychology
Advisory Committee
Advisor Name Title
Finney, Jack W. Committee Chair
Cooper, Robin K. Panneton Committee Member
Jones, Russell T. Committee Member
Ollendick, Thomas M. Committee Member
Scarpa-Friedman, Angela Committee Member
  • Self-Efficacy
  • Utilization
  • Children
  • Health Care
  • Primary Care
Date of Defense 2001-04-06
Availability mixed
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


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