Barriers to uptake of services for coronary heart disease: qualitative study

ObjectivesTo identify factors within the South Yorkshire coalfields that influence use of health services by people with angina.DesignQualitative study using semistructured individual and group interviews.SettingGeneral practice and community settings in Barnsley and Rotherham health authorities.Participants14 patients with stable angina and nine primary care staff had individual interviews plus five community groups and one group of general practitioners.ResultsA complex web of factors was identified that prevented, delayed, or facilitated referral to secondary care. Delay, denial, and self management by patients meant that the full extent of symptoms often remained hidden from general practitioners, resulting in a delayed or missed referral. Barriers identified fell into six categories: structural, personal, social and cultural, past experience and expectations, diagnostic confusion, and knowledge and awareness.ConclusionsMany of the factors influencing referral operate before general practitioners become involved. Community development could be one way of tackling inequalities and promoting sustainable change. Structural changes are needed to improve access and increase the acceptability of general practice services. Primary care staff should be educated to detect underreporting of symptoms and promote appropriate referral.

What is already known on this topic

An inverse correlation has been shown between deprivation and cardiac revascularisationFear of hospitals, denial of ill health, and low expectations may prevent people with angina accessing health services

What this study adds

Fear, denial, and low expectations were important barriers to accessing health services, reinforcing earlier findingsOther factors may be specific to the study population—for example, coping, independence, and attributing symptoms to industrially related lung diseaseMany of the barriers operate before general practitioners are involved, making it difficult to identify solutions