Exploring factors that contribute to delay in seeking help with diabetes related foot problems: a preliminary qualitative study using Interpretative Phenomenological Analysis

Abstract Background and aim: A significant number of patients with diabetes do not always seek help when they develop a foot problem such as an ulcer. This delay in patients presenting with foot problems has been attributed to poor outcomes such as lower limb amputation and premature mortality. The aim of this study was to explore patients' reasons for delay in seeking help with foot problems. Methods: A qualitative study using Interpretative Phenomenological Analysis (IPA), which used semi-structured interviews. A purposeful sample of six patients with delayed help-seeking behaviour were recruited from a diabetic foot clinic, in the United Kingdom. Interviews were audio-recorded and transcribed verbatim, then analysed in a six-step model using the IPA method. Results: The study identified nine superordinate themes associated with delay in seeking help with foot problems, these included: the level of prior foot care information; awareness of the foot problem; the ability to perform foot care behaviours; ulcer presentation and risk perception; competing priorities; the use of self-management strategies for the foot problem; the presence of specific help-seeking triggers; comorbid conditions and concurrent illness; and delayed secondary referral. Conclusions: The findings of this preliminary study suggest that, to reduce patient delay, there is a need to increase awareness among patients as well as health professionals of the risks of foot problems. Ongoing foot care education needs to be given to patients in order to enhance knowledge on foot care, including the early warning signs of foot problems and what they should do to get help. It is also necessary to ensure that patients who have problems in being able to self-monitor their feet are subject to enhanced surveillance.