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

Objectives: To identify factors within the South Yorkshire coalfields that influence use of health services by people with angina. Design: Qualitative study using semistructured individual and group interviews. Setting: General practice and community settings in Barnsley and Rotherham health authorities. Participants: 14 patients with stable angina and nine primary care staff had individual interviews plus five community groups and one group of general practitioners. Main outcome measures: Barriers to accessing health services. Results: A 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. Conclusions: Many 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.