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Socioeconomic differences in experiences with treatment of coronary heart disease: a qualitative study from the perspective of elderly patients
  1. Sara Lena Schröder,
  2. Astrid Fink,
  3. Matthias Richter
  1. Institute of Medical Sociology, Martin Luther University Halle-Wittenberg, Medical Faculty, Halle (Saale), Germany
  1. Correspondence to Sara Lena Schröder; sara.schroeder{at}


Objectives This qualitative study aims to analyse socioeconomic differences in patients’ experiences along the treatment pathway for coronary heart disease (CHD).

Design A longitudinal qualitative study using in-depth semistructured interviews to explore patients’ experiences with treatment was conducted. We analysed the transcripts of the records according to qualitative content analysis and identified differences between patients with lower and higher socioeconomic status (SES) by comparing and contrasting the narratives.

Setting The University Hospital in Halle (Saale), Germany.

Participants 41 elderly patients (aged 59–80 years) who suffered from CHD.

Results From various patient’s experiences along the pathway of care which were found to differ according to SES we derived three major themes: (1) information: patients with higher SES had greater knowledge about treatment and could use medical records as sources of information; (2) illness perception: patients with lower SES focused on improving symptoms and survival, while patients with higher SES focused on physical performance and disease management; and (3) perceived role in healthcare: patients with lower SES tended to delegate responsibility to healthcare professionals.

Conclusions Differences in the patient’s knowledge about treatment, their perceived role in healthcare and illness perception can be the factors and mechanisms that contribute to explain socioeconomic inequalities in the treatment of CHD. These factors should be considered in quantitative studies to better understand the disparities in treatment and mortality. We suggest that improving patient–physician communication and patient knowledge can change the patient’s understanding of CHD and their perceived role in healthcare and reduce inequalities in CHD treatment.

Trial registration number DRKS00007839.

  • health services research
  • socioeconomic status
  • coronary heart disease
  • qualitative research
  • healthcare inequalities
  • health services accessibility

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  • Contributors SLS wrote the initial draft of this manuscript, collected data and analysed the transcripts. MR and AF conceptualised and designed the project, helped interpreting the data and critically reviewed the manuscript. All authors have read and approved the final version of the manuscript.

  • Funding This work was supported by the Wilhelm Roux Programme of the Medical Faculty of Martin Luther University, Halle-Wittenberg with grant number FKZ: 28/40.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical Review Committee of the Medical Faculty of Martin Luther University, Halle-Wittenberg (No. 2014–95).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Participants of this study were guaranteed that only the study research team would have access to the interviews and transcripts thus data are not available for sharing.

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