A meta-synthesis of the cycle of financial strain, coping behaviors and health outcomes across the life course.

Background: The lived experience and impact of financial strain on broad physical and mental health outcomes is important and yet underexplored. Improving our depth of understanding of the relationship between financial strain and health may offer important insights to address this complex phenomenon.

Objective: The primary objective of this study was to conduct a meta-synthesis of existing qualitative literature that investigated or described the relationship between financial strain and health outcomes.

Methods: A search using Web of Science, PsycINFO, and PubMed identified 18,624 peer-reviewed manuscripts from 2009 to 2021 that examined the impact of financial strain on health outcomes. Selection for inclusion was limited to qualitative studies that included a research question or thematic finding related to financial strain. Literature reviews and non-U.S. based manuscripts were excluded. Selected studies (n = 25) underwent evaluation and thematic analysis using meta-synthesis methods.

Results: Twenty-five qualitative studies with a combined total of 1385 participants examined financial strain in relation to health. We identified three themes: 1) Financial strain: An intersection of threats to meeting basic needs; 2) Financial strain across the life course and intergenerational stress; and 3) The cycle of financial strain, coping behaviors and health outcomes. Our conceptual framework proposes that financial strain cyclically influences health outcomes, with threats to meeting basic needs resulting in decision making and coping that lead to disparities in health outcomes. We propose this model for further hypothesis generation and qualitative inquiry.

Conclusion: This meta-synthesis emphasizes the importance of considering the intersectionality of insecurities that affect safety and health and the need for adopting a life course perspective when researching the lived experience of financial strain. The complexity of the relationship between financial strain, coping behaviors, and health outcomes merits innovative approaches and further study.