From fear to faith: older adults’ emergency care journey in rural Turkey

Guided by the World Health Organization’s (WHO) Age-Friendly Health Systems Model, this study explores the emergency department (ED) experiences and treatment adherence of adults aged 65 and older arriving by ambulance at a rural Turkish hospital, in a low-literacy, religious context. This qualitative descriptive study used semi-structured interviews and culturally tailored emotion cards with 30 purposively sampled participants (mean age: 71.2, SD = 4.8; 53.3% female; 33% rural, 43% district center, 24% city center). Data were thematically analyzed using MAXQDA 2022, with in vivo and in vitro coding. Reliability was ensured via Cohen’s Kappa (0.90) and transcript verification; validity was supported by maximum variation sampling and data triangulation. The study adhered to the COREQ checklist. Four themes emerged: ED access journey, treatment and adherence experiences, staff communication dynamics, and age-friendly service perceptions. Participants experienced an emotional arc from fear (88%) during ambulance transport to trust (76.7%) at triage and relief (92%) at discharge, supported by rapid triage, staff empathy, and family support, but challenged by navigational barriers and accessibility issues for disabled participants (23.3%). Cultural idioms (e.g., “I felt intense fear”) and the prayer-bead icon highlighted spiritual coping. Participants perceived rapid triage as enhancing feelings of safety, fostering trust. Rapid triage and empathetic communication fostered trust and adherence, while navigational and accessibility barriers persisted. Findings advocate for culturally sensitive, age-friendly ED designs, offering scalable tools like emotion cards and triage protocols for rural healthcare equity globally, aligned with SDG 3.