title: Money is Brain: Financial Barriers and Consequences for Canadian Stroke Patients.
abstract: BACKGROUND
  Stroke patients of lower socioeconomic status have worse outcomes. It remains poorly understood whether this is due to illness severity or personal or health system barriers. We explored the experiences of stroke patients with financial barriers in a qualitative descriptive pilot study, seeking to capture perceived challenges that interfere with their poststroke health and recovery.
  
  
  METHODS
  We interviewed six adults with a history of stroke and financial barriers in Alberta, Canada, inquiring about their: (1) experiences after stroke; (2) experience of financial barriers; (3) perceived reasons for financial barriers; (4) health consequences of financial barriers; and (5) mechanisms for coping with financial barriers. Two reviewers analyzed data using inductive thematic analysis.
  
  
  RESULTS
  The participants developed new or worsened financial circumstances as a consequence of stroke-related disability. Poststroke impairments and financial barriers took a toll on their mental health. They struggled to access several aspects of long-term poststroke care, including allied health professional services, medications, and proper nutrition. They described opportunity costs and tradeoffs when accessing health services. In several cases, they were unaware of health resources available to them and were hesitant to disclose their struggles to their physicians and even their families.
  
  
  CONCLUSIONS
  Some patients with financial barriers perceive challenges to accessing various aspects of poststroke care. They may have inadequate knowledge of resources available to them and may not disclose their concerns to their health care team. This suggests that providers themselves might consider asking stroke patients about financial barriers to optimize their long-term poststroke care.
authors.affiliation: 1Calgary Stroke Program,Cumming School of Medicine Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada.
authors.forename: Aravind
authors.initials: A
authors.lastname: Ganesh
authors.affiliation: 3Cumming School of Medicine Department of Community Health Sciences,Institute of Public Health,Libin Cardiovascular Institute, and Faculty of Nursing,University of Calgary,Calgary,Alberta,Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: King-Shier
authors.affiliation: 4Cumming School of Medicine Departments of Medicine and Community Health Sciences,Institute of Public Health,Libin Cardiovascular Institute,University of Calgary.Calgary,Alberta,Canada.
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
authors.affiliation: 5The Calgary Stroke Program,Cumming School of Medicine Departments of Clinical Neurosciences,Radiology, and Community Health Sciences,Calgary,Alberta,Canada.
authors.forename: Michael D
authors.identifier: http://orcid.org/0000-0002-6269-1543
authors.initials: MD
authors.lastname: Hill
authors.affiliation: 7Cumming School of Medicine Departments of Medicine and Community Health Sciences,University of Calgary,Alberta,Canada.
authors.forename: David J T
authors.initials: DJ
authors.lastname: Campbell
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta; D017281:Cost of Illness; D006233:Persons with Disabilities / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D036301:Qualitative Research; D020521:Stroke / Q000191:economics / Q000523:psychology / Q000628:therapy
keywords: Cerebrovascular disease; Communication; Doctor-patient relationship; Education; Financial barriers; Health services research; Outcomes research; Qualitative research; Quality of care; Stroke