Healthy diet in Canadians of low socioeconomic status with coronary heart disease: Not just a matter of knowledge and choice

People of low socioeconomic status (SES) are prone to premature coronary heart disease (CHD) and tend to have more risk factors and worse health and mortality. Yet, little is understood about the specific challenges faced by people of low SES with CHD in changing behavior around the consumption of dietary risk factors, such as salt, fat, and cholesterol, and adding heart-healthy foods, such as fruit, vegetables, lean meat, and fish. The aim of this study was to understand factors promoting and reducing willingness and capacity to consume a healthy diet in people of low SES with CHD. Qualitative research via semistructured interviewing and a critical realist theoretic framework was used, along with a questionnaire to provide context for the interviews. Food consumption and diet were not principally related to knowledge but were constrained by an ever-present scarcity of resources and the need to prioritize other daily living expenses perceived as being more important than diet. Having use of a vehicle also promoted access to dietary support from physicians and cardiac rehabilitation.