Parental beliefs and children's receipt of preventive care: another piece of the puzzle?

Access to health care is a leading indicator for Healthy People 2010 (USDHHS 2000). Access is “the timely use of personal health services to achieve the best possible health outcomes” (Millman 1993). For children, routine visits are an important indicator of realized access to care, in contrast to health insurance and regular source of care, which measure potential access (Sissman 1992; Andersen 1995). Preventive visits are important for many reasons, including the opportunity to provide immunizations, check for appropriate development, screen for problems such as lead exposure, and address parental concerns. They also enable early intervention when problems are identified and they reduce hospitalization (Hakim and Bye 2001). The American Academy of Pediatrics (AAP) recommends annual well-child visits from ages 3 to 20, except for ages 7 and 9 (AAP 1995). Yet, nationally representative surveys have shown that 19–26 percent of children lacked routine care in the past year (St. Peter, Newacheck, and Halfon 1992; Ronsaville and Hakim 2000; Yu et al. 2002). Improving access has been a goal of health care reform, including the State Children's Health Insurance Program to extend health insurance to uninsured children. Health insurance has been linked to use of routine services (Wood et al. 1990; St. Peter, Newacheck, and Halfon 1992; Holl et al. 1995; Tallon and Sandman 1998; Eisert and Gabow 2002; Yu et al. 2002). Insurance is one piece of the access-to-care puzzle; nonfinancial barriers must be also addressed (Sissman 1992; Loue 1993; Kohrman 1994; Perrin et al. 1994; Zuvekas and Weinick 1999; Fry-Johnson et al. 2005). The behavioral model of health services utilization describes utilization as a function of predisposing, enabling, and need characteristics (Aday and Andersen 1974). The literature on preventive care suggests that utilization depends on predisposing factors such as child's age, race/ethnicity, and parental education; enabling factors such as family income, health insurance, and regular source of care; and need factors such as child's health status (Wood et al. 1990; Short and Lefkowitz 1992; St. Peter, Newacheck, and Halfon 1992; Cornelius 1993; Holl et al. 1995; Tallon and Sandman 1998; Eisert and Gabow 2002; Yu et al. 2002; Buescher et al. 2003; Alio and Salihu 2005; Kempe et al. 2005; Chung et al. 2006; Selden and Hudson 2006). Children depend on their parents for health care, yet little is known about the role of parental beliefs and routine care. Andersen (1995) has described health beliefs as “attitudes, values, and knowledge that people have that might influence their subsequent perceptions of need and use of health services.”. It is unclear whether parents perceive regular preventive visits as unimportant or if they are deterred by obstacles. The few studies of parental beliefs and preventive care have been limited to immunizations for young children and have shown mixed results (Becker et al. 1977; Kviz, Dawkins, and Ervin 1985; Strobino et al. 1996; Prislin et al. 1998). The present study examined whether parental beliefs about the frequency of checkups were related to children's timely utilization of routine care. Because there have been very few multivariable analyses of predictors of routine visits among children from 3 to 18 years of age, a secondary aim was to elucidate which factors, besides parental beliefs, were independently related to children's receipt of routine care.