Barriers to prevention and timely presentation of diabetic foot ulcers: Perspectives of patients from a high-risk urban population in the United States

Abstract

Diabetic foot amputation is a preventable complication that is increasing in incidence in the United States, with disparities across geography, race, ethnicity, and income. This qualitative study explored the experiences of people in a low-income urban area in the United States in preventing and obtaining care for foot ulcers. Sixteen adults with foot ulcers were identified through purposive sampling based on records of hospital stays and primary care visits. Semi-structured interviews were transcribed and analyzed for key themes. Participants described inadequate understanding of diabetic foot disease: many sought care only after developing advanced symptoms. They identified social and health system factors as barriers to timely access to care. Some participants described a realization of the seriousness of their condition and an ability to improve self-care after developing an ulcer. Patients' experiences can inform the design of amputation-reduction initiatives to achieve more desirable results, including enhanced self-management capabilities, timely access, and attention to social determinants. [End Page 1554]

_Methods_ _Setting_

This qualitative study was conducted in the Bronx, N.Y., in the United States. The Bronx is a racially and ethnically diverse and socioeconomically disadvantaged urban inner-city whose amputation rates are among the highest in the nation.13 The study was approved by the Institutional Review Board of Montefiore Medical Center. No researcher had conflicts of interest. Participants

Bronx residents with current or recent diabetic foot ulcers were identified through purposive sampling. Patients were identified through two pathways: (1) inpatient censes for wound and vascular surgery consultation services were reviewed to identify patients admitted with complications of diabetic foot ulcers, and (2) electronic health data were reviewed to identify primary care patients who had outpatient visits in the previous six months for a diabetic foot ulcer. All potential participants were initially contacted by a treating physician regarding the study, and those who [End Page 1555]