A vicious cycle: employment challenges associated with diabetes foot ulcers in an economically marginalized Southwest US sample.

Kelly N B Palmer, Rebecca M Crocker, David G Marrero, Tze-Woei Tan
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Abstract

Aim: To describe patients' reported employment challenges associated with diabetic foot ulcers (DFUs).

Methods: Fifteen patients from under-resourced communities in Southern Arizona, with a history of DFUs and/or amputations, were recruited from a tertiary referral center from June 2020 to February 2021. Participants consented to an audio-recorded semi-structured phone interview. Interviews were transcribed and thematically analyzed using the Dedoose data analysis platform.

Results: Participants shared a common theme around the cyclic challenges of DFU prevention/management and employment. Those employed in manual labor-intensive jobs or jobs requiring them to be on their feet for long durations of time believed working conditions contributed to the development of their DFUs. Patients reported work incapacity due to declines in mobility and the need to offload for DFU management. Many expressed frustration and emotional distress related to these challenges noting that DFUs resulted in lower remuneration as medical expenses increased. Consequently, loss of income and/or medical insurance often hindered participants' ability to manage DFUs and subsequent complications.

Conclusion: These data illuminate the vicious cycle of DFU and employment challenges that must be addressed through patient-centered prevention strategies. Healthcare providers should consider a person's contextual factors such as employment type to tailor treatment approaches. Employers should establish inclusive policies that support patients with DFUs returning to work through flexible working hours and adapted work tasks as needed. Policymakers can also mitigate employment challenges by implementing social programs that provide resources for employees who are unable to return to work in their former capacity.

恶性循环:美国西南部经济边缘化样本中与糖尿病足溃疡相关的就业挑战。
目的:描述患者报告的与糖尿病足溃疡(DFUs)相关的就业挑战。方法:从2020年6月至2021年2月从三级转诊中心招募了15名来自南亚利桑那州资源不足社区的患者,这些患者有DFUs和/或截肢史。参与者同意接受录音的半结构化电话采访。使用Dedoose数据分析平台对访谈进行转录和主题分析。结果:参与者围绕DFU预防/管理和就业的周期性挑战分享了共同的主题。那些从事体力劳动密集型工作或需要长时间站立的工作的人认为,工作条件有助于他们的dfu的发展。患者报告由于活动能力下降和需要卸载DFU管理而丧失工作能力。许多人对这些挑战表示沮丧和情绪困扰,指出由于医疗费用增加,dfu导致薪酬降低。因此,收入和(或)医疗保险的损失往往阻碍了参与者处理dfu和随后并发症的能力。结论:这些数据阐明了DFU的恶性循环和就业挑战,必须通过以患者为中心的预防策略来解决。医疗保健提供者应该考虑一个人的背景因素,如就业类型来定制治疗方法。雇主应制定包容性政策,通过灵活的工作时间和根据需要调整的工作任务,支持dfu患者重返工作岗位。政策制定者还可以通过实施社会项目来缓解就业挑战,这些项目为无法以以前的身份重返工作岗位的雇员提供资源。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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