title: Parental information, motivation, and adherence behaviors among children with sickle cell disease.
abstract: BACKGROUND
  Identification of psychosocial correlates of health care utilization has become an important strategy in improving clinical care. The objective of the study was to examine the fit of the Information-Motivation-Behavioral Skills (IMB) model, applied to health care utilization among children with sickle cell disease (SCD).
  
  
  METHODS
  Participants were parents of 150 children, ages 1-17 years, receiving care in a sickle cell center. Parents completed questionnaires assessing information, motivation, adherence behaviors, and other factors with respect to SCD management. Data regarding health care utilization in the previous 12 months were obtained from parent report and electronic medical records. Stepwise multiple regression analysis was conducted to determine associations between IMB factors and health care use.
  
  
  RESULTS
  Parents rated highly in the domains of information, motivation, and adherence behaviors for managing their child's SCD. Children of parents reporting higher satisfaction with social supports had higher odds (OR 1.49, 95% CI 1.03-2.15) of two or more routine hematology visits in the previous 12 months. Neither information nor adherence behavior was associated with urgent or routine care use. Among other variables measured, high parental illness-related stress and child health status reported as fair/poor were the strongest predictors of urgent care use while private insurance type was the strongest predictor of routine care use.
  
  
  CONCLUSIONS
  Among IMB factors, social support was associated with routine health care utilization. Social support and parental illness-related stress may serve as important, modifiable targets in interventions to allocate needed resources to families and reduce unnecessary medical care.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Hematology/Oncology, Houston, Texas 77030, USA. Raphael@bcm.edu
authors.forename: Jean L
authors.initials: JL
authors.lastname: Raphael
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Butler
authors.forename: Tiffany L
authors.initials: TL
authors.lastname: Rattler
authors.forename: Marc A
authors.initials: MA
authors.lastname: Kowalkowski
authors.forename: Brigitta U
authors.initials: BU
authors.lastname: Mueller
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Giordano
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009042:Motivation; D010287:Parent-Child Relations; D010290:Parents; D010349:Patient Compliance / Q000523:psychology*; D012044:Regression Analysis; D012944:Social Support; D011795:Surveys and Questionnaires