title: Non-urgent accident and emergency department use as a socially shared custom: a qualitative study.
abstract: OBJECTIVE
  We explored attitudes of non-urgent accident and emergency department (AED) patients in the middle-income healthcare setting Saint Vincent and the Grenadines (SVG) in the Caribbean to understand how and why they decide to seek emergency care and resist using primary care facilities.
  
  
  METHODS
  In 2013, we conducted 12 semistructured interviews with a purposive sample of non-urgent AED users from a variety of social backgrounds. Verbatim transcripts were analysed with a grounded theory approach.
  
  
  RESULTS
  In this study, we found, first, that participants automatically chose to visit the AED and described this as a locally shared custom. Second, the healthcare system in SVG reinforced this habitual use of the AED, for example, by health professionals routinely referring non-urgent cases to the AED. Third, there was also some deliberate use; patients took convenience and the systemic encouragement into account to determine that the AED was the most appropriate choice for healthcare.
  
  
  CONCLUSIONS
  We conclude that the attitudes and habits of the Vincentian non-urgent patient are major determinants of their AED use and are intricately linked to local, socially shared practices of AED use. Findings show that health services research should reconsider rational choice behaviour models and further explore customs of health-seeking.
authors.affiliation: Public Health Group, Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados.
authors.forename: Simone
authors.initials: S
authors.lastname: Keizer Beache
authors.affiliation: Public Health Group, Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Guell
mesh_terms: D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D019436:Saint Vincent and the Grenadines; D055815:Young Adult
keywords: emergency department; primary care
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