title: Exploring the impact of financial barriers on secondary prevention of heart disease.
abstract: BACKGROUND
  Patients with coronary artery disease experience various barriers which impact their ability to optimally manage their condition. Financial barriers may result in cost related non-adherence to medical therapies and recommendations, impacting patient health outcomes. Patient experiences regarding financial barriers remain poorly understood. Therefore, we used qualitative methods to explore the experience of financial barriers to care among patients with heart disease.
  
  
  METHODS
  We conducted a qualitative descriptive study of participants in Alberta, Canada with heart disease (n = 13) who perceived financial barriers to care. We collected data using semi-structured face-to-face or telephone interviews inquiring about patients experience of financial barriers and the strategies used to cope with such barriers. Multiple analysts performed inductive thematic analysis and findings were bolstered by member checking.
  
  
  RESULTS
  The aspects of care to which participants perceived financial barriers included access to: medications, cardiac rehabilitation and exercise, psychological support, transportation and parking. Some participants demonstrated the ability to successfully self-advocate in order to effectively navigate within the healthcare and social service systems.
  
  
  CONCLUSIONS
  Financial barriers impacted patients' ability to self-manage their cardiovascular disease. Financial barriers contributed to non-adherence to essential medical therapies and health recommendations, which may lead to adverse patient outcomes. Given that it is such a key skill, enhancing patients' self-advocacy and navigation skills may assist in improving patient health outcomes.
authors.affiliation: Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
authors.forename: Kirnvir K
authors.initials: KK
authors.lastname: Dhaliwal
authors.affiliation: Faculty of Nursing, University of Calgary, Calgary, AB, Canada.|Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.|O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.|Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: King-Shier
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.|O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.|Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.|Department of Medicine, Cumming School of Medicine, University of Calgary, Health Sciences Centre, G236, 3330 Hospital Drive NW, Calgary, AB, T2N 1 N4, Canada.
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.|O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.|Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.|Department of Medicine, Cumming School of Medicine, University of Calgary, Health Sciences Centre, G236, 3330 Hospital Drive NW, Calgary, AB, T2N 1 N4, Canada.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
authors.affiliation: Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.|Department of Medicine, Cumming School of Medicine, University of Calgary, Health Sciences Centre, G236, 3330 Hospital Drive NW, Calgary, AB, T2N 1 N4, Canada.|Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: James A
authors.initials: JA
authors.lastname: Stone
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. dcampbel@ucalgary.ca.|Department of Medicine, Cumming School of Medicine, University of Calgary, Health Sciences Centre, G236, 3330 Hospital Drive NW, Calgary, AB, T2N 1 N4, Canada. dcampbel@ucalgary.ca.
authors.forename: David J T
authors.initials: DJ
authors.lastname: Campbell
mesh_terms: D000368:Aged; D000416:Alberta; D017281:Cost of Illness; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006331:Heart Diseases / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D055502:Secondary Prevention / Q000191:economics*; D011795:Surveys and Questionnaires
keywords: Cardiac rehabilitation; Coronary artery disease; Financial barriers; Qualitative research; Secondary prevention