Significant variability in the use of primary care services by children with similar health issues points to the need for a greater understanding of factors that influence pediatric health care use. Approximately one in eight children are classified as “consistently high” users of health care services (falling in the top third of a distribution of heath care use), while a similar number of children are classified as “consistently low” users of health care services. Atypical patterns of utilization are of concern for a number of reasons. Inappropriately low use may increase public health risks by limiting children’s receipt of immunization. Rare or infrequent use of health care services may fail to adequately protect individual and community child health. High use may increase the risk for iatrogenic harm to the child and may place strain on the health care system. Child health status is clearly a driving force behind a parent’s decision to seek pediatric health care services .

However, a number of other factors have been linked to health care use. Child psychosocial concerns are frequently associated with increased use of pediatric health care services. These concerns often include internalizing and externalizing behaviours, peer interaction difficulties, learning disabilities, and other school-related difficulties. Given the critical role of parents in the decision to seek medical care for their children, it is not surprising that a number of parent variables have also been included in analyses of pediatric utilization, including parental psychopathology and parental social support. The strongest parental predictor of pediatric utilization is maternal health care use, with greater maternal use of these services consistently linked to greater use of pediatric health care cess factors , child age , family size , and family conflict .

Despite these positive findings, multivariate studies incorporating many of these variables routinely account for little more than a third of the variance in pediatric health care use. Furthermore, the literature does not present a coherent picture of the processes that drive and maintain diverse patterns of pediatric primary care services. As primary care physicians take on a greater role as gatekeepers of the health care system, better understanding of the diverse factors that influence a parent’s decision to seek physician assistance are critical to ensure that families are connected with the services best suited to address their concerns. The present study tested elements of an adapted social-cognitive model that explains processes involved in the parent’s decision to seek pediatric primary care services . This model is based on the interaction of parenting stress and parental self-efficacy for coping with general parenting and daily stressors. Previous results examining the relationship between stress and child health care have been mixed . However, an explanation for these discrepant findings may lie in the definition of stress. Stressors can be viewed as objectively observed stimuli, while stress is a response to certain stressors in the environment , “threat is not a fixed property of situational events. Rather, it is a relationship property concerning the match between perceived coping capabilities and potentially hurtful aspects of the environment”.

Examining potential stressors along with factors that may moderate the influence of potential stressors may provide a better understanding of the influences of stress on pediatric utilization. For example, research looking at the relationship between self-efficacy and stress has found that not only is self-efficacy a moderator between demanding situations and stressful outcomes, but it can be critical in helping parents function adaptively when faced with various demands. Furthermore, an investigation of the relationship between stress, family competence, and pediatric help seeking found that while stress was not correlated with pediatric contacts, the interaction between family support and daily hassles was related to pediatric health care.