Table 1.

Major domains identified in focus groups with women with asthma about what they are doing to address health-related financial challenges with asthma management.

Domain	Descriptors	Example
Acceptance of the status quo	Passive acceptance of the situation and cognitive appraisals of considering alternatives were described as helpful in managing asthma despite financial hardship. Prayer assisted with this acceptance for some individuals.	“if you get stressed out about it, then your asthma gonna get worse. It gets worse. Put it in the pile. Like you can’t just sit there and just be over-defeated about all the medical bills because you have to focus on what you can do. So, I’m like I can pay my rent, but I cannot pay this $2000 bill, so I’m not gonna get upset because I’ll be right back in the hospital. And start to get more $2,000 bills. So, might as well don’t even worry about it. I’m gonna do what I can do”.
Stockpiling medicines	Keeping an abundant supply of medicines was helpful in preparing for times when affordability concerns may arise.	“I keep so much medication, I’m the pharmacy. What I do, I just go through it every season. You know, I keep down the dates, and I throw them out”.
Utilizing community assistance programs	Community assistance programs were easy to navigate for some participants in order to obtain low-cost or free medicines, while others were unaware of these options.	“They don’t require a lot of documents. And the people that handle it are very, um, accommodating. So, because they want you to – that’s what the money is for. So, they want you to get access to it. So, they’re very accommodating. You know? I think the only, um, documents you have to provide is, uh, if you have a W2 form, um, if you’re employed, um, um, your check pay check or something. That’s what I did. I had zero. You had zero income, and that’s good. You don’t have to go any further than that”.
Reaching out to health care providers & social networks	Negotiating out-of-pocket payments with health care providers and pharmacists, initiating these concerns and relying on family members were ways in which participants social networks and care teams were described as a helpful resource in addressing cost-related concerns. These networks provided several helpful options including payment options, renting equipment, utilizing office samples of medicines.	“when I didn t have insurance, that gap, I let my doctor know ahead of time, so I was able to negotiate with her how much I was gonna pay for that visit. I say everything is negotiable. That s the way I look at it.”
Foregoing self-management and seeking urgent care	Decisions are made around foregoing routine care and medicines, and obtaining needed care through urgent care facilities.	“when you don t have insurance, the way you manage asthma is through the emergency room. So, you will literally wait until you have to go –an attack, and the only way you can get medication is to go to the emergency room.”