Table 1. Factors tested in the regression
Socio demographic, socio economic , and health Programme theories from realist review Other issues from literature
1. Age group
2. Sex
3. Ethnic group
4. Geographical region
5. Household with children aged <5 years
6. Social class (based on the Standard Occupational Classification from the UK Office Of National Statistics)
7. Social deprivation quintiles (measured using Index of Multiple Deprivation16)
8. Urban/rural status
9. Personal access to internet
10. Car ownership
11. Presence of limiting long-term illness
12. General healtha
Uncertainty causes anxiety. Items:1. Worry pain is a sign of something serious.2. Not confident in deciding when to see a doctor.aPrevious traumatic event. Item:3. Did not see doctor in past when the health problem was serious.
Need to get back to normal. Items:4. Seeks help if problem causes sleep loss.5. Seeks help if problem impacts on work.
Seeking pain relief. Item:6. Does not take medication to stop pain.
Stressful lives cause difficulty coping so low burden services sought. Items:7. Feel overwhelmed when have a health problem.a8. Find life stressful.9. Has no one to care for them if ill.a10. Difficulty taking time off work to see a GP.11. Ease of travel to an emergency department.12. Opening hours of health services problematic.a13. Preference for services with no appointments.a14. Desire for services open at times convenient to them.a15. Willingness to wait in a waiting room to be seen that day.
Follow advice of trusted others. Item:16. Check what to do with family and friends.
Perceptions and experiences of services. Items:17. Preference for emergency departments because can get tests done quickly.a18. Beliefs about emergency department doctors knowing more than GPs.a19. No confidence in their GP.a
Frustration with access to GP. Items:20. Ease or difficulty getting GP appointment.21. Whether registered with GP.22. Whether responsibilities make it difficult to see a GP.a23. Belief that people use emergency departments because they can’t get a GP appointment.
Awareness of services. Items:1. Confidence in knowing the range of services available.2. Confidence in finding opening times of services.3. Confidence in knowing what tests are available where.4. Confidence in how to contact a GP out of hours.5. Likelihood of looking up a problem on the internet.6. Likelihood of looking up where to go on the internet.
Recursivity and/or learnt behaviour.17 Item:7. See having tests done as validating attendance at a service.aHealth literacy, measured using the Health Literacy Questionnaire.18 Two of the 9 domains of this instrument were used, each 5 items long. Items:8. Ability to communicate with health professionals.a9. Ability to understand health information.aRecent use of services for self or others. Items:10. When last used emergency ambulance.11. Frequent use of ambulance.12. When last used emergency department.13. Frequent use of emergency department.14. When last used GP.
Perceptions of service overuse. Items:15. Beliefs that too many people use 999 ambulance unnecessarily.16. Too many people use emergency departments.17. Too many people use GP.18. People are reluctant to use emergency departments.
  • a Variable on self-completed part of questionnaire.