Grant: Travel Awards - Institute Community Support

Background: In the context of ongoing budgetary constraints in health systems globally, understanding health service utilization (HSU) is of critical importance. Theoretical models and frameworks of HSU are useful for conceptualizing HSU and guiding nursing research, but sensitize researchers to varying concepts, thereby impacting how HSU is viewed and evaluated. Purpose: To describe, compare and contrast three models and one theoretical framework applicable to the study of HSU and how they might inform nursing knowledge and theory. Methods: Three models and one theoretical approach were chosen based on their relevance to HSU. Analysis was guided by Chinn and Kramer's (2004) criteria for theory critique, including an analysis of the purpose, concepts, relationship, structure and assumptions. Analysis of converging and diverging themes was conducted in the contemporary and seminal literature with an attention to nursing research and theory. Results: The Health Belief Model (HBM), Network Episode Model (NEM), Ecological Systems Theory (EST) and Behavioral Model of Health Service Utilization (BMHSU) were chosen for their relevance in guiding HSU research, particularly in the context of nursing research. Whereas the BMHSU was developed specifically to explore HSU, the other models have been tailored for use in HSU studies. Analysis revealed significant variations in the breadth and depth of phenomena these models attend to, thereby presenting challenges with operationalization in the context of nursing research. Conclusions: Theoretical approaches to the study of HSU have broadened in recent years, but approaches that consider social influences more specifically, as in the NEM and EST, glean valuable data for nursing research. An attention to the data sources, operationalization and research methods associated with each model, will greatly influence HSU data. Applicability of these models to nursing focuses on the importance of documenting nurses' work