Work

Factors influencing emergency department utilisation using Andersen’s behavioural model: a cross-sectional study in a public hospital in Malaysia

Year: 2026

Type: article

Abstract: Introduction Overcrowding in emergency departments (EDs) remains a critical issue, commonly driven by non-urgent visits associated with behavioural, socioeconomic, and system-level factors. Methods This cross-sectional study was conducted in the emergency department of Hospital Tengku Ampuan Rahimah Klang, Malaysia, in 2023, involving convenience-sampled adult Malaysian visitors in the green zone. Respondents completed a structured questionnaire based on Andersen’s behavioural model to assess predisposing, enabling, and need factors, as well as ED utilisation patterns. Data were analysed with SPSS 29.0 using descriptive statistics and multiple logistic regression, with significance set at p < 0.05. Results Among the 381 respondents, most were young adults, low-income earners, and perceived their conditions as urgent despite presenting with non-critical symptoms. In exploring the reasons for ED attendance, respondents frequently cited trust in care quality and the proximity of the facility as key reasons for choosing ED over other care options. Multiple analysis revealed that marital status, insurance coverage, and illness duration had a significant impact on attempts to access alternative services. Being married was associated with increased ED visit frequency in the past 12 months, while insurance coverage and illness duration were notably linked with ED visits. These findings highlight how predisposing (marital status), enabling (insurance coverage), and need (illness duration) factors, as framed by Andersen’s behavioural model, shape ED utilisation patterns. Conclusion Understanding these dynamics provides a foundation for developing strategies that combine behavioural insights with stronger primary care access, patient education, and service planning. Such measures are essential to reduce non-urgent ED visits, alleviate overcrowding, and enhance the efficiency of Malaysia’s public healthcare system.

Source: Frontiers in Public Health

DOI: 10.3389/fpubh.2026.1731516

Authors: Norbaidurah Ithnain, Saiful Adli Suhaimi, Evi Diana Omar, Hasnah Mat, Ahmad Tajuddin Mohamad Nor, Manimaran Krishnan

Institutions: Ministry of Health, National Institutes of Health, Tengku Ampuan Rahimah Hospital

Language: English

Topic: Emergency and Acute Care Studies

Subfield: Emergency Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801