Healthcare-seeking intentions of middle-aged and elderly individuals with critical diseases: an expanded TPB model in the post-pandemic era

The COVID-19 pandemic posed a significant threat to global public health, particularly affecting Taiwan's middle-aged and elderly populations. Fear of infection led patients with critical illnesses to delay seeking medical care, disrupting disease management and quality of life. This study applies an expanded Theory of Planned Behavior (TPB) model, incorporating "perceived risk" and "trust," to examine healthcare-seeking behavior during the pandemic and provide insights for improving healthcare accessibility and reducing mortality rates.This study utilized the Theory of Planned Behavior (TPB) as the foundational framework, encompassing three core constructs: "attitude," "subjective norm," and "perceived behavioral control." To further examine the "behavioral intentions" of patients with critical illnesses in making healthcare decisions during the COVID-19 pandemic, two additional constructs, "perceived risk" and "trust," were integrated. A cross-sectional study design and purposive sampling method were employed, collecting 526 valid questionnaires. Partial Least Squares (Smart PLS) subsequently analyzed and validated the structural equation model.Among five primary dimensions influencing healthcare-seeking behavioral intentions, "trust" had the most significant impact (β = 0.373, p < 0.001), followed by "attitude," "perceived risk," "perceived behavioral control," and "subjective norm." Trust in hospitals was notably stronger than trust in individual physicians. Additionally, patients with hypertension, hyperglycemia, and hyperlipidemia exhibited significant variations in healthcare-seeking intentions.The findings highlight the critical role of trust in healthcare systems, underscoring the need for transparent communication and safe environments. The results suggest strategies for improving healthcare accessibility and patient trust in a post-pandemic context.