# Cardiovascular Health and Financial Hardship: Protocol for a Qualitative Citizen Science Study

## TL;DR

This study explores how financial hardship affects cardiovascular health, focusing on experiences of people with lower income to help prevent heart disease.

## Contribution

The study introduces a citizen science approach to investigate the link between financial hardship and cardiovascular disease, emphasizing sex and gender differences.

## Key findings

- The study will generate insights into how financial hardship contributes to late recognition of cardiovascular disease.
- Citizen scientists will co-create knowledge through qualitative interviews and creative methods.
- Recommendations will be developed to reduce health inequalities related to cardiovascular disease.

## Abstract

Cardiovascular disease (CVD) is the leading cause of death worldwide. Individuals with lower income or experiencing financial hardship face a significantly higher risk of developing CVD. However, there is a lack of in-depth insight into their experiences with CVD, and specific attention to women is essential.

The In a Heartbeat study aims to understand the relationship between CVD and financial hardship and enable earlier recognition and prevention of CVD among both women and men. In this study protocol, we describe our citizen science study, in which we unravel the mechanisms and contexts through which financial problems lead to the development and late recognition of CVD.

The main data for this study are collected by citizen scientists through qualitative lifeline interviews. All citizen scientists have experience with financial hardship, and some also have experience with CVD. We hold weekly project team meetings with citizen scientists and professional scientists in which we use methods such as photo elicitation, critical-creative hermeneutic analysis, design thinking, a dynamic learning agenda, and regular individual and group evaluations of the citizen science process.

The study was funded in October 2024 and started in January 2025. Data collection started in November 2025 and is expected to end halfway through 2026. Four qualitative lifeline interviews had been conducted as of December 6, 2025. Data analyses are planned for 2026. Manuscripts reporting findings on the central research question and the process evaluations will be submitted for publication in 2027.

Toward the end of the study in 2027, we will develop and disseminate concrete recommendations for various stakeholders to prevent CVD and recognize CVD earlier among people with financial hardship. In all our analyses and recommendations, we will consider sex and gender differences. Our study could contribute to a reduction in health inequalities.