Study Procedures
Interviews were conducted in English or Spanish using Zoom or WhatsApp per participant preference. Participants completed a brief sociodemographic survey to assess age, race and ethnicity, sex, role (AYA or caregiver), health literacy,31 income, education/employment, and insurance type. The interview guide was developed by our study team in consultation with key stakeholders, including an AYA advocate and clinicians with experience caring for AYA patients (Supplemental material).32 The interview guide drew on published frameworks of financial toxicity and burden2,33,34 to allow for open-ended responses from participants regarding how they may or may not have experienced material hardship, psychological responses, or coping behaviors due to financial factors. Additionally, interviewers were trained to probe about potential processes or resources that might reduce financial toxicity or address unmet needs.35 All study materials were available in English or Spanish. Participants were contacted during the analysis for member checking, a methodologic approach to ensure accuracy and enhanced credibility of results.36