{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T11:58:52Z","timestamp":1765886332517,"version":"3.48.0"},"reference-count":29,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2022,7,8]],"date-time":"2022-07-08T00:00:00Z","timestamp":1657238400000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,6,6]]},"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine the association between the perception of COVID-19 risk, confidence in health services and avoidance of emergency department (ED) visits in Portugal during the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Community-based, cross-sectional survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Volunteer sample that completed the online survey between April 2020 and May 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>987 participants who perceived needing ED care. Of those, 242 reported avoiding ED visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Logistic regression models for ED avoidance were conducted to estimate the effect of risk perception and confidence in health services, adjusted for sociodemographics, health status and time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The adjusted odds for ED avoidance were higher for participants lacking confidence in health service response to non-COVID-19 conditions (adjusted OR: 6.39; 95% CI 3.19 to 12.82) and COVID-19 (1.81; 1.19 to 2.77) and lower for those perceiving a low risk of being infected at a health provider (0.16; 0.07 to 0.38).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In our sample, confidence in health services and risk perception of infection at a health provider were associated with the decision to avoid the ED. These results suggest that policymakers and care providers need to mitigate the negative consequences of delayed healthcare; be aware of the implications of distrust and fear from those in need of healthcare and provide equally distributed safe alternatives to ED care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-058600","type":"journal-article","created":{"date-parts":[[2022,7,8]],"date-time":"2022-07-08T10:38:16Z","timestamp":1657276696000},"page":"e058600","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Association between perception of COVID-19 risk, confidence in health services and avoidance of emergency department visits: results from a community-based survey in Portugal"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6048-396X","authenticated-orcid":false,"given":"S\u00edlvia","family":"Lopes","sequence":"first","affiliation":[{"name":"NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal"},{"name":"Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5033-9115","authenticated-orcid":false,"given":"Patr\u00edcia","family":"Soares","sequence":"additional","affiliation":[{"name":"NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal"},{"name":"Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal"}]},{"given":"Ana","family":"Gama","sequence":"additional","affiliation":[{"name":"NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal"},{"name":"Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal"}]},{"given":"Ana Rita","family":"Pedro","sequence":"additional","affiliation":[{"name":"NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal"},{"name":"Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal"}]},{"given":"Marta","family":"Moniz","sequence":"additional","affiliation":[{"name":"NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal"},{"name":"Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal"}]},{"given":"Pedro","family":"Laires","sequence":"additional","affiliation":[{"name":"NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal"},{"name":"Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal"}]},{"given":"Ana Rita","family":"Goes","sequence":"additional","affiliation":[{"name":"NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal"},{"name":"Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal"}]},{"given":"Carla","family":"Nunes","sequence":"additional","affiliation":[{"name":"NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal"},{"name":"Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal"}]},{"given":"S\u00f3nia","family":"Dias","sequence":"additional","affiliation":[{"name":"NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal"},{"name":"Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal"}]}],"member":"239","published-online":{"date-parts":[[2022,7,8]]},"reference":[{"key":"2025121509354709000_12.7.e058600.1","unstructured":"Portugal. 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