Health Care Utilization among Young Adults in Primary and Emergency Health Care : The Need for Support, the Capacity to Support, and the Communication in between

Sammanfattning: Swedish health care has set an aim of working towards ‘a good and integrated care’ with focus on patient-centred care in an effort to strengthen patient autonomy and improve accessibility. Problems with accessibility in earlier research have been associated with non-urgent complaints, especially at emergency departments (EDs). In addition, the use of EDs for non-urgent complaints has been connected to difficulties getting an appointment at primary health care centres (PHCs). Among non-urgent health care visits, young adults (age 18-29 years) are overrepresented. When studying health care utilization, the significance of health literacy permeates its different compounds, as associated with health care utilization.  The overall aim of this thesis was to gain a deeper understanding of young adults’ health care utilization within EDs and PHCs by describing and exploring their use of health care in relation to perceived needs and prerequisites.    The design of this thesis was primarily explorative. Data collection was performed using interviews and observations with young adults visiting selected primary and emergency health care units, doing focus groups with health care personnel working at selected health care units, and by performing text analysis of online health information web sites.  In addition, a retrospective and cross-sectional overview was designed using registry data and questionnaires to identify health care use in a Swedish context. Data were analysed using statistical analyses, grounded theory, and two kinds of content analyses.   Results demonstrated that, in terms of doctor visits, young adults did not seek care to a greater extent than other age groups. As a young adult, the seeking of emergency care was characterized mainly by abdominal and chest pain, symptoms of short duration, and recommendations to seek care by a health care professional. Insufficient and/or problematic health literacy was found in more than one-third of the young adults seeking health care and was associated with anxiety about symptoms, lower reliance on health care, and seeking care for psychological symptoms. When exploring young adults’ health care utilization, the sense of being taken seriously emerged as their main concern. Further-more, the seeking of health care should be considered a process rather than isolated visits where external influences, clarity of symptoms, behavioural approaches, health care know-how, and enabling self-management were important factors in understanding health care utilization. For health care personnel, the question of non-urgent care among young adults was a question of the distribution of responsibility; young adults were considered to put too much responsibility on health care to get healthy. The young adults had great concerns, were unable to wait, demonstrated other needs for communication, and were influenced by external information. The perception of young adults’ health care utilization was also associated with difficulties within the health care set-ting. Contributing factors were that each health care unit was just a small part of an enormous health care system, having to deal with tough priorities and to work with different ethical dilemmas. Nonetheless, health care personnel felt comfortable meeting young adults based on experience, either their own or by asking others. When scrutinizing external influence, online health information was found to be foremost basic, helping the reader in narrowing down possible diagnoses. However, a modified dimension was also present, in which the reader had to balance alternatives, making it difficult for young adults to come to a decisive conclusion on what to do with symptoms.  The findings from this thesis demonstrate that it is the interactions between young adults and health care that enable factors for future patient empowerment and for health literacy to emerge and develop, thereby enabling future self-care. By acknowledging young adults primarily as newcomers to adult health care in need of support rather than part of a relatively healthy group, seeking care for non-urgent problems could possibly alter alternative attitudes and prejudices. Emphasizing adjustments within each health care meeting has the chance to empower and still achieve the goal of effective health care.