In China, a rational healthcare seeking pattern in children has not yet taken shape amid the active promotion of the implementation of hierarchical medical system, one major cause of which may be inadequate implementation of first contact in primary care settings in children due to poor service capability for children of these institutions. Therefore, it is of great practical significance and application value to analyze the influencing factors of children's intention to seek healthcare in primary healthcare institutions.

To investigate children's intention to seek healthcare in primary healthcare settings and associated determinants, offering insights into the development of a sound and rational healthcare-seeking pattern in children.

Two surveys were conducted during March to July, 2021 using a questionnaire developed based on the Anderson's Behavioral Model of Health Services Use (containing three aspects: demographics of children and their guardians, children's opinions on hospital selection for treatment and associated factors, and intention to seek healthcare in primary care. One survey was offline, with children aged 0-14 years as participants accidental sampled from people in two grade A tertiary general hospitals, three community health centers, and other public places (such as public parks and squares) in Guangzhou's urban areas, and the other one was online, with a purposive sample of age-matched children included in a WeChat group as participants. For collecting information more appropriately, the questionnaire was completed by the children's guardians. Univariate and multivariate ordinal regression were used to identify factors associated with children's intention to seek healthcare in primary care.

Altogether, the results of questionnaires effectively answered by the guardians of 501 children were used for analysis. The prevalence of intending to seek healthcare in primary care in the children was 36.53% (183/501). The prevalence of primarily choosing a primary healthcare setting for initial treatment of common diseases was 26.3% (132/501), which were mainly owing to shorter distance between home and the hospital (83.3%, 110/132), shorter waiting time for treatment (40.9%, 54/132) and having a pediatric or general practice clinic (36.4%, 48/132). Multivariate Logistic regression analysis indicated that the level of intention to seek healthcare in primary care in children was increased if the nearest hospital was a primary hospital instead of a secondary or tertiary hospital〔OR (95%CI) =1.514 (1.060, 2.166) 〕. Visiting a primary hospital at least four times in the last year was associated with a higher level of intention to seek healthcare in primary care in children compared with visiting a primary hospital zero times〔OR (95%CI) =0.248 (0.111, 0.557) 〕. A higher level of intention to seek healthcare in primary care in children was associated with parents' high level of satisfaction with primary care services instead of parents' fair level of satisfaction with primary care services〔OR (95%CI) =0.348 (0.236, 0.515) ] or parents' dissatisfaction with primary care services〔OR (95%CI) =0.086 (0.043, 0.173) 〕.

In general, the children in Guangzhou mainly seek healthcare in nearby hospitals, and the their level of intention to seek healthcare in a primary hospital could be improved greatly. To improve their satisfaction with primary care services and intention to seek healthcare in primary care settings, it is suggested to further deepen the theoretical research and practical exploration regarding hierarchical diagnosis and treatment, strengthen the cooperation between primary and higher level hospitals for balancing the distribution of pediatric medical resources among hospitals, and to improve the pediatric service capabilities of primary hospitals via improving the software and hardware configuration of these hospitals.