Exploring Healthcare-Seeking Behavior Intentions of Middle-Aged and Elderly Individuals with Critical Illnesses in Taiwan under the COVID-19 Pandemic (Preprint)

Abstract

Taiwan is grappling with the profound implications of a rapidly aging demographic, a trend contributing to an increased burden of critical illnesses. These diseases are now emerging as predominant contributors to mortality rates in the country. This demographic shift poses complex healthcare challenges and necessitates a reevaluation of resource allocation and care strategies to accommodate the escalating needs of this vulnerable segment of the population.

In the wake of the COVID-19 pandemic, healthcare environments have encountered unprecedented risks, exacerbating the vulnerabilities of middle-aged and elderly individuals, especially those with pre-existing critical illnesses. This heightened risk landscape accentuates the critical need to closely analyze the factors influencing healthcare-seeking behavior in this demographic. Understanding their intentions and decision-making processes in seeking medical attention is now more crucial than ever to ensure that their healthcare needs are met effectively and safely during such a global health crisis.

This study applied the Theory of Planned Behavior and examined critical illness patients' “behavioral intention” during COVID-19. Constructs such as “attitude,” “subjective norm,” “perceived behavioral control,” “perceived risk,” and “trust” were considered. Data from 526 valid questionnaires were analyzed using smart partial least squares structural equation modeling.

All 17 hypotheses within the research framework, including five major constructs and 12 sub-constructs, were supported. Trust emerged as the most significant construct, followed by attitude, perceived risk, perceived behavioral control, and subjective norm. The sub-constructs mediated the relationship between the major constructs and behavioral intention. Notably, there were significant differences in the healthcare behavioral intention model among the three common critical illnesses (hypertension, diabetes mellitus, and hyperlipidemia).

The expanded Theory of Planned Behavior offers a comprehensive framework for understanding the complex factors that influence the healthcare-seeking behaviors of middle-aged and elderly populations, particularly those with critical illnesses, in the context of the COVID-19 pandemic. This theoretical model illuminates how attitudes, subjective norms, perceived behavioral control, perceived risk, and trust interact to shape the intentions and decisions of these individuals when accessing healthcare services during a time of heightened vulnerability and public health challenges.

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