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

## TL;DR

This study explores why people visit emergency departments in Malaysia, finding that factors like marital status, insurance, and perceived urgency influence their decisions.

## Contribution

The study applies Andersen’s behavioral model to identify specific factors influencing non-urgent emergency department visits in a Malaysian public hospital.

## Key findings

- Marital status was associated with increased ED visit frequency in the past 12 months.
- Insurance coverage and illness duration significantly influenced attempts to access alternative services.
- Trust in care quality and facility proximity were key reasons for choosing ED over other care options.

## Abstract

Overcrowding in emergency departments (EDs) remains a critical issue, commonly driven by non-urgent visits associated with behavioural, socioeconomic, and system-level factors.

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.

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.

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.