Primary care

Socioeconomic variations in responses to chest pain: qualitative study

Helen Mary Richards, clinical research fellow, ^a Margaret Elspeth Reid, head of department, ^b Graham Charles Murray Watt, head of department. ^c

^a Highlands and Islands Health Research Institute, University of Aberdeen, The Green House, Beechwood Business Park, Inverness IV2 3ED, ^b Department of Public Health, University of Glasgow, Glasgow G12 8RZ, ^c Department of General Practice, University of Glasgow, Glasgow G12 0RR

Correspondence to: H M Richards hmr{at}hihri.abdn.ac.uk

Objective: To explore and explain socioeconomic variations in perceptions of and behavioural responses to chest pain.
Design: Qualitative interviews.
Setting: Community based study in Glasgow, Scotland.
Participants: 30 respondents (15 men and 15 women) from a socioeconomically deprived area of Glasgow and 30 respondents (15 men and 15 women) from an affluent area of Glasgow.
Outcome measures: Participants' reports of their perceptions of and actions in response to chest pain.
Results: Residents of the deprived area reported greater perceived vulnerability to heart disease, stemming from greater exposure to heart disease in family members and greater identification with high risk groups and stereotypes of cardiac patients. This greater perceived vulnerability was not associated with more frequent reporting of presenting to a general practitioner. People from the deprived area reported greater exposure to ill health, which allowed them to normalise their chest pain, led to confusion with other conditions, and gave rise to a belief that they were overusing medical services. These factors were associated with a reported tendency not to present with chest pain. Anxiety about presenting among respondents in the deprived area was heightened by self blame and fear that they would be chastised by their general practitioner for their risk behaviours.
Conclusions: Important socioeconomic variations in responses to chest pain may contribute to the known inequities in uptake of secondary cardiology services. Primary care professionals and health promoters should be aware of the ways in which perceptions of symptoms and illness behaviour are shaped by social and cultural factors.