Department of Pediatrics (SK Burns, TT Doan, and KN Ray), University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, PA.
Department of Medicine (T Krishnamurti), University of Pittsburgh School of Medicine, PA.
Acad Pediatr. 2023 Sep-Oct;23(7):1326-1336. doi: 10.1016/j.acap.2023.02.011. Epub 2023 Mar 4.
To understand US parent health care-seeking decisions in the context of multiple in-person and telehealth care options. As the health care landscape evolves, new research is needed to explain how parents now decide when and where to seek acute pediatric health care.
We applied a mental models approach, focusing on the archetypal example of care-seeking for pediatric acute respiratory tract infections (ARTIs), by first reviewing pediatric ARTI guidelines with 16 health care professionals to inform 40 subsequent semi-structured interviews with parents of young children in 2021. Interviews were qualitatively coded using thematic analysis, with code frequency and co-occurrence informing the final influence model of parent health care-seeking decisions.
Parent interviewees identified 33 decisional factors which were synthesized into seven dimensions influencing care-seeking decisions: perceived illness severity, perceived child susceptibility, parental self-efficacy, expected accessibility of care, expected affordability of care, expected quality of clinician, and expected quality of site. The first three dimensions (perceived severity, perceived susceptibility, parental self-efficacy) influenced an initial decision about whether to seek care, while all seven factors influenced a subsequent decision about where to seek care (eg, in-person primary care, primary care-based telehealth, urgent care, direct-to-consumer telehealth). Uncertainty was present within many dimensions (eg, severity, access, quality) indicating potential targets to support parent decision-making processes and optimize care-seeking behaviors.
A mental models approach identified dimensions influencing parent choice to seek care and choice of care site for children with ARTIs, suggesting targets to advance family-centered practice and policy.
了解美国父母在多种面对面和远程医疗选择的情况下寻求医疗保健的决策。随着医疗保健领域的发展，需要新的研究来解释父母现在如何决定何时何地寻求急性儿科保健。
我们应用了心智模型方法，通过首先审查 16 名医疗保健专业人员的儿科急性呼吸道感染 (ARTI) 指南，为随后的 40 次半结构化访谈提供信息，这些访谈于 2021 年与幼儿的父母进行。访谈使用主题分析进行定性编码，使用代码频率和共现来告知父母医疗保健寻求决策的最终影响模型。
家长受访者确定了 33 个决策因素，这些因素被综合为影响寻求护理决策的七个维度：感知疾病严重程度、感知儿童易感性、父母自我效能感、预期护理的可及性、预期护理的可负担性、预期临床医生的质量以及预期的护理地点的质量。前三个维度（感知严重程度、感知易感性、父母自我效能感）影响了是否寻求护理的初步决策，而所有七个因素都影响了随后关于在哪里寻求护理的决策（例如，面对面的初级保健、基于初级保健的远程医疗、紧急护理、直接面向消费者的远程医疗）。许多维度（例如，严重程度、获取、质量）都存在不确定性，这表明存在潜在的目标，可以支持父母的决策过程并优化寻求护理的行为。
心智模型方法确定了影响父母为患有 ARTI 的儿童寻求护理和选择护理地点的决策的维度，这表明存在目标，可以推进以家庭为中心的实践和政策。
