title: Factors associated with reluctance to use an emergency department in a multi-ethnic community: results of a telephone survey.
abstract: BACKGROUND
  Delays in seeking emergency care when experiencing serious symptoms may increase morbidity and mortality. Understanding the reasons for such delays may result in interventions to reduce them. We examined the relationship between ethnicity and the reluctance to use an emergency department (ED).
  
  
  METHODS
  An exploratory multilingual telephone survey was completed in Greater Vancouver, British Columbia, with randomly selected men and women, aged 40 years and older, listed in the BC Ministry of Health Services Client Registry Database. Survey items included whether the respondents were "somewhat," "very" or "not" reluctant to use an ED. Reasons for reported degree of reluctance and potential correlates were explored including age, gender, income, education, anxiety, vulnerability, self-reported health status, life stress, and satisfaction with a previous ED visit. Multiple logistic regression analysis was conducted.
  
  
  RESULTS
  Among 973 (56% response rate) participants (56.3% female) were 149 Chinese, 67 South Asian, 221 foreign-born (not Chinese or South Asian), and 536 Canadian-born participants (not Chinese or South Asian). Controlled for all potential confounders, Chinese (OR = 0.30, 95% CI = 0.19, 0.48) respondents were less likely than Canadian-born participants to report reluctance to use an ED. Anxiety (OR = 1.05, 95% CI = 1.02, 1.09) and dissatisfaction with a previous ED visit (OR = 1.85, 95% CI = 1.27, 2.68) were significant correlates.
  
  
  CONCLUSIONS
  Canadian-born participants may be at higher risk of delaying necessary treatment from EDs that have been publicized to have long waiting times. Further studies are needed to understand the role ethnicity plays in ED utilization.
authors.affiliation: NEXUS, University of British Columbia, Vancouver, BC. breime@nursing.ubc.ca
authors.forename: Birgit
authors.initials: B
authors.lastname: Reime
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Tu
authors.forename: Roula
authors.initials: R
authors.lastname: Tzianetas
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Ratner
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001955:British Columbia; D019992:Databases as Topic; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology*; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D010865:Pilot Projects; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013689:Telephone; D013997:Time Factors