A qualitative exploration of the social determinants of health and self-care among women at risk of and with heart failure in Ireland

Heart failure is increasing, particularly in women over 65 years old. Diagnosis in women is slower, they are treated less aggressively and have a greater symptom burden, which is associated with more days in hospital. Physiological and social factors attribute to the heart failure burden among women leading to increased adverse outcomes for women. The aim of this research was to provide women across various socio-economic areas an opportunity to explore their real world lived experiences of the effects of Social Determinants of Health (SDH) on their self-care behaviours. Focus groups were conducted exploring social determinant of health factors affecting women both at risk and diagnosed with heart failure. Six primary care practices in different socioeconomic areas (affluent, average, below average) were contacted and referred women at risk of or diagnosed with heart failure to the research team. One additional ethnic minority group were identified as a fourth cohort. Transcripts were analysed using thematic analysis. Twenty-eight women participated in four peer-based focus groups. All groups fundamentally understood self-care. However, social determinant factors, specifically diet, healthcare access and a caring burden, dictated their capacity to enact self-care. Group differences emerged: from the affluent luxury of choice; the average sandwich generation with time constraints; the below average group were challenged by logistics of chronic illness; and the minority group prioritising survival over health choices. Four additional themes were agreed: life perspectives, the disadvantage of being a woman, loneliness and stress. The themes capture systematic gender discrimination and traditional expectations of women which have actively compromised women’s professional and physical autonomy. The findings suggest that socioeconomic status is the primary influence at the individual level as to whether a woman can engage in preventative health or is forced into a reactive survival mode. This study highlights the urgent need to address systemic inequities to improve cardiac outcomes and quality of life for women.