Finding resiliency in the face of financial barriers

Abstract

Patients with chronic diseases often face financial barriers to optimize their health. These financial barriers may be related to direct healthcare costs such as medications or self-monitoring supplies, or indirect costs such as transportation to medical appointments. No known framework exists to understand how financial barriers impact patients’ lives or their health outcomes.We undertook a grounded theory study to develop such a framework. We used semistructured interviews with a purposive sample of participants with cardiovascular-related chronic disease (hypertension, diabetes, heart disease, or stroke) from Alberta, Canada. Interview transcripts were analyzed in triplicate, and interviews continued until saturation was reached.We interviewed 34 participants. We found that the confluence of 2 events contributed to the perception of having a financial barrier—onset of chronic disease and lack of income or health benefits. The impact of having a perceived financial barrier varied considerably. Protective, predisposing, or modifying of factors determined how impactful a financial barrier would be. An individual's particular set of factors is then shaped by their worldview. This combination of factors and lens determines one's degree of resiliency, which ultimately impacts how well they cope with their disease.The role of financial barriers is complex. How well an individual copes with their financial barriers is intimately tied to resiliency, which is related to the composite of a personal circumstances and their worldview. Our framework for understanding the experience of financial barriers can be used by both researchers and clinicians to better understand patient behavior.

Financial barriers and adverse clinical outcomes among patients with cardiovascular-related chronic diseases: a cohort study

“…The fact that our overall exposure (at least one financial barrier) retained a significant positive association with disease-related hospitalization in spite of adjustment for income suggests that financial barriers may be relevant, at least for some aspects of chronic disease care, regardless of income level. Consistent with prior qualitative research [ 21 ], financial barriers appear relevant even for some patients with higher income and may not be experienced universally by those with lower income. This suggests that a patient’s perception of a financial barrier might be used in clinical and research settings as an additional measure along with standard measures of socioeconomic status (i.e.…”

“…The observed associations for those with financial barriers is potentially mediated by cost-related non-adherence to medical therapies [ 5 , 6 ] and health behaviour modification [ 31 ], which result in poorer control of chronic diseases and ultimately culminate in hospitalizations and death. We recently completed a grounded theory study on this topic where we found that the impact of financial barriers on patients’ lives is determined by a complex set of individual patient and system factors [ 21 ]. The complexity of perceiving financial barriers as well as the demonstrable association with adverse outcomes and increased costs seen in this study may provide an impetus for policymakers to seek to invest in interventions which minimize the impact of financial barriers, such as copayment elimination [ 32 ], patient navigation [ 33 ] and patient self-advocacy education [ 34 ] — though the ultimate impact of these interventions remains inconclusive.…”

“…The exposure of interest was perceiving a financial or cost-related barrier to care as defined by responses to the health surveys. In our preceding qualitative study [ 20 , 21 ], we identified that patients may experience financial barriers to a variety of goods and services that are required for disease self-management. These include (1) medications (given that cost sharing is often required); (2) indirect costs related to use of covered healthcare provider visits and laboratory investigations as well as direct costs related to healthcare provider visits that are not universally covered (eye exams and dental care); (3) access to healthful food; (4) ability to make health behaviour modifications (physical activity, weight loss and smoking cessation); and (5) home care (only those ≥75 years of age were included for this barrier).…”

Exploring structural barriers to diabetes self-management in Alberta First Nations communities

“…Our work was embedded within a larger qualitative study focused on financial barriers to care, where data was collected from 34 participants with cardiovascular-related chronic diseases, which included both FN and non-FN individuals [30]. Within this larger study, among those with diabetes, we found compelling differences in the experiences reported by participants living in FN communities and non-FN participants.…”

Elevated blood pressure and illness beliefs: a cross-sectional study of emergency department patients in Jamaica

“…Notably, the majority of these studies evaluating illness beliefs were conducted in an outpatient non-emergent setting. Financial insecurity may also account for this incongruence between disease beliefs and medication self-efficacy [ 26 , 27 ]. Even so, there was no significant discrepancy between incomes among those presenting with elevated BP compared to those presenting with normal BP.…”