Understanding young adults' reasons for seeking 'clinically unnecessary' urgent and emergency care: A qualitative interview study

Background

Studies have identified young adults as more likely to use emergency departments for ‘clinically unnecessary’ problems, with limited similar evidence for emergency ambulance use. Media portrayals depict young adults as motivated by ‘convenience’, but little research has explored the reasons for their help‐seeking behaviour.

Methods

Qualitative interviews with 16 young adults (18‐30) considered by clinicians to have made unnecessary use of emergency ambulance, emergency department or an urgent GP appointment. Data analysis was informed by interpretive phenomenological analysis.

Findings

A number of interrelated factors contributed to participants’ decisions. They were anxious about the seriousness of their symptoms, sometimes exacerbated by reduced coping capacity due to poor mental health or life stresses. They looked to others to facilitate their decision making, who sometimes encouraged urgent contact. They wanted to avoid impact on existing day‐to‐day commitments including work or study. They had strong views about different health services, sometimes based on frustration with lack of resolution of on‐going health problems. Convenience was not identified as a significant factor, although some actions could be interpreted in this light if the context was not considered.

Conclusions

Young adults make ‘clinically unnecessary’ use of urgent and emergency care for more than convenience. Their decisions need to be understood in relation to the complexity of their experience, including lack of confidence in making health‐related decisions, lowered coping capacity and concern to maintain normal daily life.

Modern health-seeking behaviour and associated factors among mothers having under 5-years old children in Shire town, Tigray, Ethiopia: A cross-sectional study 2018

Background

The practice of appropriate health care-seeking is important to reduce severe and life-threatening childhood illnesses. In Shire town, little is known about the mother’s health care-seeking behaviour on childhood illness.

Aim

To assess modern health-seeking behaviour and associated factors of mothers having under 5-years old children in Shire town.

Setting

The study setting was Shire town, northwest Tigray, Ethiopia.

Methods

A community-based cross-sectional study was conducted to interview 504 mother-child pairs by systematic random sampling technique. Data were collected through interviewer-administered semi-structured questionnaires. Data were coded, entered, cleaned and edited using EPIDATA version 3.1 and export to Statistical Package for Social Science (SPSS) Version 22.0 for analysis. To identify the significant variables, binary logistic regression was employed. Variables with p-value < 0.05 at 95% CI (confidence interval) in multivariate logistic regression were considered statistically significant.

Results

In this study, around 76.2% (72.1, 80) of mothers sought modern health care. In a multivariate logistic regression analysis at a p-value of < 0.05, caregivers with age of ≥ 28 years (AOR [adjusted odds ratios]: 1.65; 95% CI [1.02, 2.68]), educational level of secondary school and above (AOR: 0.44; 95% CI [0.23, 0.86]), child feeding per day < 8 times (AOR: 2.77; 95% CI [1.75, 4.38]) and perceived severity of illness (AOR: 2; 95% CI [1.07, 3.82]) were statistically associated with modern health care-seeking behaviour.

Conclusion

Strengthen healthcare services is recommended at the community level through information, education and communication/behavioural change strategies to improve the mother’s health care-seeking behaviour.

The interaction effect of health insurance reimbursement and health workforce on health care-seeking behaviour in China

OBJECTIVE

In China, patients generally seek health care at high-level hospitals, which is leading to escalating medical costs and overloaded hospitals. Some studies have suggested that the health system is an important factor influencing individuals' health care-seeking behaviour; however, this association has not been studied in much depth. We therefore examined the impact of the health system (in terms of the interaction between health insurance reimbursement and health workforce) on health care-seeking behaviour.

METHODS

Drawing on national survey data from 2008 and 2013, we linked individual-level data on choice of health care providers (our index of health care-seeking behaviour) with county-level data on the health workforce and health insurance. We then constructed a multilevel multinomial logistic model to examine the impacts of health insurance reimbursement (indexed as average reimbursement rate [ARR]) and the health workforce (number of registered physicians per 1000 population) at county hospitals and primary health care institutions (PHCs) on choice of inpatient care providers.

RESULTS

Increases in ARR at county hospitals were associated with a greater probability of visiting such hospitals (relative risk ratio [RRR] = 1.23), and this positive impact was even greater in county hospitals with higher physician densities (RRR = 2.76). Greater ARR in PHCs was associated with a 73% lower probability of visiting municipal- and higher-level hospitals; increasing ARR was associated with an even lower probability when physician density in PHCs was considered (RRR = 0.09).

CONCLUSION

Increases in the health insurance reimbursement and health workforce are necessary to improve health care access and thereby health care-seeking behaviour. Thus, comprehensive health system reform is necessary.

Reasons women do not seek health care for dysmenorrhea

AIMS AND OBJECTIVES

To identify and describe reasons women do not seek health care for dysmenorrhea symptoms.

BACKGROUND

Although dysmenorrhea is highly prevalent among women, can cause significant disruptions in their daily lives, and may increase their risk for future chronic pain conditions, few women seek health care for dysmenorrhea. A better understanding of why women do not seek health care is necessary to develop strategies that facilitate care seeking and optimal symptom management.

DESIGN

A qualitative descriptive design was used to guide the study and summarise text responses to an open-ended survey question.

METHODS

Participants in an online survey study who had not sought health care for dysmenorrhea (N = 509) were asked to write about their reasons for not seeking care. Data were collected in January and February 2015. Participants' text responses were analysed using qualitative content analysis.

RESULTS

Nine categories of reasons were identified as follows: assuming symptoms are normal, preferring to self-manage symptoms, having limited resources, thinking providers would not offer help, being unaware of treatment options, considering symptoms to be tolerable, being wary of available treatments, feeling embarrassed or afraid to seek care and not seeking health care generally.

CONCLUSIONS

Findings can guide the development of strategies to promote care seeking and inform policy and clinical practice to improve dysmenorrhea management.

RELEVANCE TO CLINICAL PRACTICE

Findings underscore the need to provide routine screening for dysmenorrhea, avoid dismissing dysmenorrhea symptoms, initiate discussions and provide education about dysmenorrhea, provide treatments options based on evidence and women's preferences and raise public awareness of dysmenorrhea and its impact.

Associations between health care seeking and socioeconomic and demographic determinants among people reporting alarm symptoms of cancer: a population-based cross-sectional study

BACKGROUND

Late diagnosis of cancer may partly be explained by the fact that some patients do not seek health care promptly when experiencing an alarm symptom. Socioeconomic and demographic differences exist concerning knowledge and awareness of cancer alarm symptoms in the general population and socioeconomic differences are found in cancer incidence and survival. We therefore hypothesise that socioeconomic and demographic differences in health care-seeking behaviour are present among people with alarm symptoms.

OBJECTIVES

To analyse associations between health care seeking and socioeconomic and demographic factors among people reporting cancer alarm symptoms.

METHODS

A questionnaire survey comprising 20000 people aged >20 from the Danish population. The questionnaire concerned alarm symptoms of common cancers and subsequent health care seeking. Data on socioeconomic factors were obtained from Statistics Denmark.

MAIN OUTCOMES

health care seeking and patient interval.

RESULTS

A total of 26.1% of all subjects reported that they did not seek health care when having experienced an alarm symptom. Women-subjects aged >40, subjects living with a partner and subjects having a cancer diagnosis-were more likely to seek health care, whereas medium educational level was negatively associated with health care seeking. Further, women were more likely to seek health care within 1 month, whereas subjects out of the workforce were less likely to do so.

CONCLUSIONS

Approximately three out of four subjects sought health care when having experienced an alarm symptom but 50% waited for at least 1 month. Some demographic factors were found to be associated with health care-seeking behaviour and the patient interval, whereas no consistent associations were found with regard to socioeconomics.