Family influences in a cross-sectional survey of higher child attendance

Background: a quarter of all consultations are for children, but there is little quantitative evidence documenting what parental factors are important in the decision to consult.Aim: to assess parental factors in higher child attendance (three or more times per year) — the 32% responsible for most (69%) general practice consultations with children.Design of study: a random sample of 40 individuals (one per household), including 670 children.Setting: six general practices within a 30-mile radius of the administrative centre.Method: parents completed a postal questionnaire for themselves and their child. The adult questionnaire documented lifestyle, attitude to doctors and medicine, Kokko's personality types, perceived health, health anxiety, number of medical problems, medically unexplained somatic symptoms, and willingness to tolerate symptoms. The child questionnaire documented perceived health, the number of medical problems, somatic symptom inventory, willingness to tolerate symptoms, and self-reported attendance.Results: adjusted odds ratios, test for trend, 95% confidence intervals.) A response rate of 490/670 (73%) paired adult and child questionnaires was obtained. Reported higher attendance was valid compared with the notes (likelihood ratio positive test = 5.2, negative test = 0.24), and was independently predicted by the child's age, medical problems, council house occupancy, and by the parents' assessment of the severity of the child's ill health. After controlling for these variables, higher attendance was more likely if the parents were higher attenders (adjusted OR = 3.71, 95% CI = 2.31-5.98), and if they perceived their children had medically unexplained physical symptoms (MUPS) (for 0, 1, 2, 3+ symptoms; adjusted ORs (95% CIs) = 1, 3.1 (1.7-5.7), 2.30 (0.97-5.5), 4.2 (1.8-9.6) respectively; P 0.001). Attendance was less likely if they were willing to tolerate symptoms in their children (score for seven normally self-limiting scenarios = 0-17, 18-29 and 30+; adjusted ORs = 1,0.71, 0.39 respectively; Z for trend P = 0.03). Willingness to tolerate symptoms and parental perception of child MUPS were associated with council house tenancy and health anxiety. Parents' perception of child MUPS also related to perception of child health and the parents' own MUPS. Parents of higher attenders were more likely to be depressed (HAD depression scale = 0-7, 8-10, 11+ respectively; adjusted ORs (95% CIs) = 1, 2.04 (1.27-3.27), 1.60 (0.75-3.42)) or anxious (anxiety scale 0-7, 8-10, 11+ respectively; adjusted ORs [95% CIs] = 1, 1.60 [0.99-2.58], 1.97 [1.20-3.26]).Conclusion: important parental factors are council house tenancy, the parents' perception of, and willingness to tolerate, somatic symptoms in the child, and the parents' own attendance history, health anxiety, and perception of somatic symptoms. Doctors should be sensitive to the parental and family factors that underlie the decision to consult and of the needs of parents of high-attending children