Parents are commonly faced with difficult decisions about when and where to seek medical care for their children. The difficulty and complexity of these decisions has increased in recent decades with the emergence of novel models of care delivery (e.g., urgent care, retail-based clinics, telemedicine) in addition to traditional options (e.g., primary care, emergency departments (EDs)).1, 2, 3, 4 These novel care models offer increased convenience and, as a consequence, have dramatically shifted pediatric visit patterns in the US. For example, increasing numbers of US children experienced visits through commercial direct-to-consumer (DTC) telemedicine throughout the 2010s,5 followed by rapid growth in availability and uptake of practice-based primary care telemedicine in the 2020s during the coronavirus pandemic.6 With this greater variety of options, parents must navigate more complex care-seeking decisions but lack evidence-based tools to fully inform these decisions. While protocols focused on clinical symptoms exist to support families and primary care offices in assessing whether care is needed and with what urgency,7 they do not yet incorporate guidance on appropriateness of virtual care or account for individualized priorities in the context of local options.

One common reason for problem-based pediatric visits across all sites of care is acute respiratory tract infections (ARTIs). ARTIs are a cluster of diagnoses that include bacterial infections (e.g., acute otitis media, streptococcal pharyngitis, sinusitis) and viral infections (e.g., viral pharyngitis, viral upper respiratory tract infections) which can present with varied symptoms (e.g., cough, congestion, fever). Together, ARTIs comprise nearly one-third of acute pediatric primary care visits, nearly half of commercial DTC telemedicine visits, and one-fifth of pediatric ED visits in pre-pandemic data.5, 6, 8 Given the volume of ARTI visits across these varied care sites, ARTIs offer an ideal case in which to investigate how families make choices around when and where to seek care. Whereas prior studies of this decision have primarily focused on a binary choice (e.g., seek care vs. stay home),9, 10, 11 this choice must now be examined in the context of multiple different care options.

Mental models methodology offer an approach to understand complex decision-making processes, such as parents’ decisions about health care-seeking for pediatric ARTIs. The mental models approach, grounded in behavioral decision science, is a methodology for capturing individuals’ intuitive theories of complex decision domains in their own natural formulation.12, 13 This approach has been successfully applied in numerous health contexts, including emergency contraception use,14 immunizations,15 and high-risk pregnancies.16 The mental models approach begins with an professional expert model, summarizing the scientific evidence and professional expert opinions on best practices, followed by the collection of end-user perspectives from experts of their own lived experience (i.e. parents with young children) on how they approach the same choices. Mental models are then represented with influence diagrams in which nodes in the diagram indicate variables (beliefs, values, and constraints) that affect a decision. These variables are connected to relevant decisions, with the weight of the line and arrowheads indicating the strength and directionality of the relationships. Subsequently, the observation of similarities and differences between technical experts and the non-technical population can be used to direct behavioral interventions, communications, or policy that address key misunderstandings, offer timely needed information, support value-concordant decision-making, and redesign systems to better meet family needs and expectations.

Here, we use the mental models approach to address a critical knowledge gap in understanding how parents approach health care-seeking decisions in the context of multiple care site options. We aimed to define parent mental models when making care-seeking decisions, focusing on the common condition of pediatric ARTIs, in order to inform future interventions.