Poverty Proofing health care: a qualitative study of barriers to accessing health care for low income families with children in Northern England

Poverty impacts negatively on children’s health and future life chances. Access to the UK’s National Health Service (NHS) is based on clinical need rather than the ability to pay but horizontal inequities in access exist. Children North East, a charity supporting children experiencing poverty, wanted to develop a Poverty Proofing© Health tool to help NHS services reduce the impacts of poverty on access. This study aimed to understand barriers to healthcare access faced by families living on low incomes to support development of the tool. Twenty parents and seven Voluntary Community Social Enterprise sector staff participated in qualitative interviews or focus groups. Data were analysed thematically, and three main themes were identified as impacting access to health care: hidden costs, securing appointments and developing relationships with health care providers. We conclude that low-income families experience both financial and other barriers to accessing NHS health care and that these barriers are exacerbated for low income families living in rural areas. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Newcastle University Research Ethics Committee gave ethical approval for this work(Reference: 2236/15258 Date: 23/11/2021). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Due to the sensitive nature of the questions asked in this study and personal information shared, as well as our ethics approval, research participants were assured raw data would remain confidential and would not be shared.