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To ascertain why people attend hospital emergency departments (ED) for low complexity health problems.A phenomenological, interactionist, qualitative study was performed. A theoretical sample that selected one urban and one rural area from Catalonia (Spain) was designed. In each setting, persons (n = 36) who had used the ED or a primary care emergency service 1 month before the beginning of the study were chosen. Data were obtained through 8 focus groups. An interpretative content analysis was performed, and emergent categories were constructed through research triangulation.Five categories emerged: symptoms, whether or not self-diagnosis was involved, perception of needs, awareness of the health services available, and the overall context of the person. Symptoms generated feelings of failing health and thus initiated care seeking. Self-diagnosis determined perceived need and the type of care sought. People contrasted their self-perception of need with their own opinion about the health services available. The decision to go to one or other service was made as a result of this contrast, but the individual's family, work, and social situations also played a part. Informants were more familiar with the service provided by the ED than with that provided by primary care. Time consumption also figured heavily in decision making.The presence or absence of self-diagnosis is a determining factor in attendance at EDs. Other factors that influence demand are the level of awareness of the health services available, previous experiences, and the life situation of the individual.

ResumenObjetivoConocer por qué las personas acuden a los servicios de urgencia hospitalarios (SUH) por problemas de salud de baja complejidad.MétodoSe realizó una investigación cualitativa de tipo fenomenológica interaccionista. La muestra teórica pertenecía a un área urbana y otra rural de Cataluña. Se escogieron personas (n = 36) que habían acudido a los SUH o a servicios de urgencia de la atención primaria de salud (SUAP) en el mes previo a su selección. Se recogieron datos en 8 grupos focales. Se realizó un análisis inductivo descriptivo-interpretativo, construyendo categorías emergentes a partir de la triangulación.ResultadosEmergieron 5 categorías: síntomas, elaboración de autodiagnóstico, percepción de necesidad, conocimiento de la oferta y contexto global de la persona. Los síntomas generan la consideración de pérdida de salud y desencadenan la acción. La elaboración del autodiagnóstico determina la necesidad-tipo de atención. Del contraste entre la percepcióntipo de necesidad y el conocimiento de la oferta de los servicios, así como de la situación vital de la persona, surge la decisión de acudir a un servicio u otro y se genera la acción. El conocimiento de la oferta de los SUH es mejor que el de los SUAP. El tiempo parece básico en la toma de decisiones.ConclusionesLa elaboración de un autodiagnóstico es crítica en la determinación de la acción, pero el conocimiento de la oferta de los servicios, las experiencias previas y la situación vital de la persona modulan el tipo de demanda.AbstractObjectiveTo ascertain why people attend hospital emergency departments (ED) for low complexity health problems.MethodA phenomenological, interactionist, qualitative study was performed. A theoretical sample that selected one urban and one rural area from Catalonia (Spain) was designed. In each setting, persons (n=36) who had used the ED or a primary care emergency service 1 month before the beginning of the study were chosen. Data were obtained through 8 focus groups. An interpretative content analysis was performed, and emergent categories were constructed through research triangulation.ResultsFive categories emerged: symptoms, whether or not self-diagnosis was involved, perception of needs, awareness of the health services available, and the overall context of the person. Symptoms generated feelings of failing health and thus initiated care seeking. Self-diagnosis determined perceived need and the type of care sought. People contrasted their selfperception of need with their own opinion about the health services available. The decision to go to one or other service was made as a result of this contrast, but the individual’s family, work, and social situations also played a part. Informants were more familiar with the service provided by the ED than with that provided by primary care. Time consumption also figured heavily in decision making.ConclusionsThe presence or absence of self-diagnosis is a determining factor in attendance at EDs. Other factors that influence demand are the level of awareness of the health services available, previous experiences, and the life situation of the individual.