Table 3.

Socioeconomic vulnerabilities.

Subtheme	Quotes
Financial strain	F1: Full-time employment was not possible so there were financial concerns because I could only work part-time. Reduced finances because of part-time employment, coping with the physical challenges of household tasks like cleaning, shopping, cooking, having enough energy to socialize after doing essentials, not feeling like a burden to my family. [Female; 55-64 years; BCa; psoriasis, RAb, OAc]
	F2: Chronic pain, immune symptoms, inflammation, quality of life. Financial burden of not working, being single and living alone in Vancouver. Having energy to eat well when I am flared up, and one of the biggest, is that patients really do need to be our own advocates in order to avoid falling through cracks in the system. [Female; 35-44 years; BC; endometriosis, inflammatory bowel disease]
Disability programs are inadequate and restrictive	G1: Having a chronic, painful illness at a younger age means trying to juggle the symptoms (including crippling fatigue) with children, spouse, home responsibilities, and work. Combined with a long commute, it's almost impossible for me to spend any time taking care of myself, like getting more sleep or exercise, or eating better. I want to get better, and I know I need to take better care of myself, but I can't figure out how to make it work. I don't think there are any programs or support (at least I’ve never heard of any) for young people managing these types of issues. Most programs are geared towards the elderly. [Female; 35-44 years; BC; RA]
	G2: Trying to manage working, running a house and exercising on limited energy. Helping my children deal with the unknown and day to day issues of a chronically ill mom and finally, disability programs do not deal well with chronically ill people able to work part time. [Female; 45-54 years; ABd; lupus, Sjogren, polymyositis]
	G3: How to earn a living. No money means no options. If the government keeps rejecting disability claims because chronic arthritis is not disabled enough how does one make money? Cannot go to swimming pool or buy decent quality food to help fight inflammation, cycle becomes a revolving door. [Male; 35-44 years; BC; ASe]
Added costs of maintaining health with a chronic disease	H1: [I feel the] financial burden of not having a lot of (realistic) job options - costs associated with disease management that have no coverage (i.e., are not prescription drugs), “high cost, high quality foods,” alternative health care, gym/pool memberships, equipment, living with chronic pain -not sleeping- not easy in social situations, (bathroom availability, food/water sources available). [Female; 45-54 years; BC; UCf]
	H2: The cost of helpful therapies e.g., massage, medications, etc. [I’m] now on a disability pension, the things that support my quality of life are difficult to get. [Female; 55-64 years; BC; lupus]
	H3: I cannot afford to eat a good diet, and pay for my medications, treatments, supplements, and pay my bills on what I get from disability and the small amount I am allowed to earn. I have to choose to eat well or take the medications, I can't afford both. Without both, I cannot manage my disease well. [Female; 35-44 years; BC; lupus]
The cost of biologics	J1: My biggest concern is that the [biologic] which currently controls my RA could someday become less effective or stop working altogether, and that no other treatment will be effective. My other concern is that perhaps despite the [biologic], I could still be slowly incurring joint damage leading someday to disability and deformity. The greatest burden is managing the high cost of biologics. [Female; 55-64 years; ONg; RA]
	J2: I’m fearful of what my future holds in terms of health problems. In addition, because of the symptoms I am unable to work or obtain employment and this impacts me severely financially. The medications I am on are also costly and again cause financial burden. [Female; 45-54 years; BC; lupus]
Time and effort to manage own health care	K1: My biggest concerns are: 1) Doctors listen to what I am saying about my symptoms and not rely solely on test outcomes. 2) Take seriously my description of being in severe pain. [Female; 55-64 years; MBh; Crohn; OA]
	K2: I have to be the captain (or co-captain) of my health care team. I have poor access to my medical records. There are a lot of out-of-pocket expenses. Important to be highly health literate, taking medications forever, social stigma, low level of socializing, hard to work full time, more disability in future. [Female; 65-74 years; ON; RA, Sjogren]
	K3: Although I appreciate my doctors, I often feel they do not appreciate me asking questions or taking part in my own care. I am very experienced with this disease. I find they push for invasive diagnostic procedures promising no pain, when in the end there is pain. I know they are trying to help but I think treating UC [ulcerative colitis] patients is not their favourite thing. I wish health professionals learned more about the day to day challenges of living with a disease such as colitis. [Female; 55-64 years; BC; UC]
	K4: Constant pain, not knowing when my hip will pop out of its socket, long term disability from work (12+ years ago) and dealing with CPP [pension plan] and long-term shortage of money due to being unable to work and do the activities I would like to do, poor balance and living alone in a small island place when my present doctor and specialists are in the greater Vancouver area. I am NOT allowed to have 2 G.P.s - so must keep the M.D. who has helped me with my condition(s) for the last 12+ years and take the ferry and bus to appointments in Victoria and Vancouver as Travel Assistance Plan forms can't be forwarded to me as the Medical Clinic on this island won't give me TAP forms and the G.P. and staff in New Westminster have no idea how to locate these forms - a nightmare! [Female; 55-64 years; BC; arthritis]

^aBC: British Columbia.

^bRA: rheumatoid arthritis.

^cOA: osteoarthritis

^dAB: Alberta.

^eAS: ankylosing spondylitis.

^fUC: ulcerative colitis.

^gON: Ontario.

^hMB: Manitoba.