Factors influencing willingness to utilize the emergency department when experiencing sickle cell disease pain crises

The emergency department (ED) is essential for treating sickle cell disease (SCD) pain crises. However, there is limited understanding of factors influencing intentions to seek ED care during these crises. Guided by the Theory of Planned Behavior (TPB), this study aimed to determine factors influencing willingness to use the ED among individuals with SCD during pain crises.

A national web-based cross-sectional survey was conducted among adults (≥ 18 years) with SCD who had visited the ED for pain crises. The survey assessed direct and indirect TPB constructs (willingness, attitude, subjective norm, and perceived behavioral control), as well as additional variables such as stigma, prior ED experience, and sociodemographic and personal characteristics. Participants were recruited through a Texas-based SCD advocacy group and a national platform that enables patients to share their disease experiences with external stakeholders. Descriptive statistics and hierarchical regression analyses were used to address the study aim.

A total of 259 responses were received, of which 114 were included in the analysis. The TPB model explained 61 % of the variance in willingness (R²=0.610, p < 0.0001). Direct attitude toward going to the ED (β=0.50, p < 0.0001) and frequency of previous ED visits (β=0.57, p = 0.0005) were the only significant predictors of willingness while controlling for sociodemographic and personal characteristics. The addition of stigma and prior ED experiences did not significantly improve the predictive utility of the TPB model.

Findings support the utility of the TPB in predicting willingness to use the ED among individuals with SCD during pain crises. Intervention strategies aimed at addressing patient attitudes may enhance willingness to use the ED during pain crises as well as the overall ED experience of individuals with SCD.