title: Gender differences in psychosocial issues affecting low-income, underserved patients' ability to manage cardiovascular disease.
abstract: OBJECTIVE
  This paper examines the psychosocial challenges that interfere with low-income, underserved patients' ability to manage cardiovascular disease (CVD) and seeks to explore the differences in how men and women manifest these issues.
  
  
  METHODS
  We convened 33 focus group discussions with low-income, underserved heart patients in 10 U.S. communities. Using content analysis, we identified key psychosocial issues that illustrate the psychosocial barriers patients experience as they manage their illness and analyzed these issues by gender to uncover differences in coping and self-management.
  
  
  RESULTS
  We identified eight factors that represent the most frequently cited psychosocial issues by participants: 1) depression; 2) fear; 3) anger; 4) disease stress; 5) financial stress; 6) social isolation; 7) burden to family and friends; and 8) social supports. For the most part, men and women characterized psychosocial problems very differently. Among the eight themes identified, four emerged as dominant themes among women participants and three emerged among male participants. One factor, depression, was a prevalent theme for both men and women.
  
  
  CONCLUSIONS
  This study suggests that low-income, underserved women and men experience gender-specific psychosocial problems that interfere with their ability to manage their disease. Programs and interventions to improve the psychosocial issues related to CVD, particularly for low-income underserved populations, may be more effective if they are designed to address the unique ways in which women and men experience their illnesses.
authors.affiliation: The George Washington University Medical Center, School of Public Health and Health Services, Department of Health Policy, Center for Health Care Quality, Washington, DC 20037, USA. Holly.Mead@gwumc.edu
authors.forename: Holly
authors.initials: H
authors.lastname: Mead
authors.forename: Ellie
authors.initials: E
authors.lastname: Andres
authors.forename: Hannah
authors.initials: H
authors.lastname: Katch
authors.forename: Bruce
authors.initials: B
authors.lastname: Siegel
authors.forename: Marsha
authors.initials: M
authors.lastname: Regenstein
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D010353:Patient Education as Topic; D011203:Poverty / Q000706:statistics & numerical data*; D011788:Quality of Life; D012648:Self Care / Q000523:psychology*; D017678:Sex Distribution; D012944:Social Support; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology