title: Association Between Parental Barriers to Accessing a Usual Source of Care and Children's Receipt of Preventive Services.
abstract: Preventive health services are important for child development, and parents play a key role in facilitating access to services. This study examined how parents' reasons for not having a usual source of care were associated with their children's receipt of preventive services.
  
  
  
  We used pooled data from the 2011-2014 National Health Interview Survey (n = 34 843 participants). Parents' reasons for not having a usual source of care were framed within the Penchansky and Thomas model of access and measured through 3 dichotomous indicators: financial barriers (affordability), attitudes and beliefs about health care (acceptability), and all other nonfinancial barriers (accessibility, accommodation, and availability). We used multivariable logistic regression models to test associations between parental barriers and children's receipt of past-year well-child care visits and influenza vaccinations, controlling for other child, family, and contextual factors.
  
  
  
  In 2014, 14.3% (weighted percentage) of children had at least 1 parent without a usual source of care. Children of parents without a usual source of care because they "don't need a doctor and/or haven't had any problems" or they "don't like, trust, or believe in doctors" had 35% lower odds of receiving well-child care (adjusted odds ratio = 0.65; 95% CI, 0.56-0.74) and 23% lower odds of receiving influenza vaccination (adjusted odds ratio = 0.77; 95% CI, 0.69-0.86) than children of parents without those attitudes and beliefs about health care. Financial and other nonfinancial parental barriers were not associated with children's receipt of preventive services. Results were independent of several factors relevant to children's access to preventive health care, including whether the child had a usual source of care.
  
  
  
  Parents' attitudes and beliefs about having a usual source of care were strongly associated with their children's receipt of recommended preventive health services. Rates of receipt of child preventive services may be improved by addressing parents' attitudes and beliefs about having a usual source of care. Future studies should assess causes of these associations.
authors.affiliation: 1 Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA, USA.|2 San Diego State University/University of California San Diego Joint Doctoral Program in Public Health (Epidemiology), University of California San Diego, La Jolla, CA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Bellettiere
authors.affiliation: 3 Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Emmeline
authors.initials: E
authors.lastname: Chuang
authors.affiliation: 1 Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Hughes
authors.affiliation: 1 Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
authors.forename: Isaac
authors.initials: I
authors.lastname: Quintanilla
authors.affiliation: 1 Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
authors.forename: C Richard
authors.initials: CR
authors.lastname: Hofstetter
authors.affiliation: 1 Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
authors.forename: Melbourne F
authors.initials: MF
authors.lastname: Hovell
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010290:Parents / Q000523:psychology*; D011314:Preventive Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D012923:Social Class; D011795:Surveys and Questionnaires; D014481:United States
keywords: child health care; family structure; health services research; nonfinancial barriers; usual source of care