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Author Notes:

Maya Fayfman, MD, Emory University School of Medicine, Division of Endocrinology, Metabolism & Lipids, 69 Jesse Hill Jr. Drive SE, Atlanta, GA 30303, Phone: (404) 778-1664, Fax: (404) 524-3052, maya.fayfman@emory.edu

Author Contributions. MF designed the study and wrote the first draft of the manuscript. MCS co-authored the study and critically reviewed the study design. CNA, RNW, and JLH designed the FGD script and carried out the FGD sessions. MMA performed data entry and review of the manuscript. RRJ, DCZ critically reviewed the manuscript. RRK and GEU critically reviewed the study design, manuscript and provided senior mentorship throughout the study. MF is the guarantor of this work and, as such, had full access to tall the data in the study and takes responsibility for the integrity of the data and the accuracy of the analysis.

The authors would like to thank Sierra Patterson for her efforts in patient recruitment and scheduling, Grady Memorial Hospital Diabetes Center and Transitions of Care clinic for allowing patient recruitment and providing space for conducting focus groups sessions.

No potential conflicts of interest relevant to this article are reported by the authors. GEU is partly supported by research grants from the NIH/NATS UL1 TR002378 from the Clinical and Translational Science Award program, and 1P30DK111024-01 from NIH and National Center for Research Resources. GEU has also received unrestricted support for research studies (to Emory University) from Novo Nordisk, Dexcom Inc, and Sanofi.

Subjects:

Research Funding:

This work was supported in part by the Emory Medical Care Foundation (MF and MCS), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant number P30-DK-111024 (MCS), and the Atlanta Clinical and Translational Science Institute (UL1TR000454).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Endocrinology & Metabolism
  • Diabetic foot complications
  • Diabetic foot education
  • Complications of diabetes
  • Barriers to care
  • LOWER-EXTREMITY AMPUTATION
  • HEALTH BELIEF MODEL
  • PREVENTION PROGRAM
  • LIMB AMPUTATION
  • EDUCATION
  • ADHERENCE
  • ULCERS

Barriers to diabetic foot care in a disadvantaged population: A qualitative assessment

Tools:

Journal Title:

JOURNAL OF DIABETES AND ITS COMPLICATIONS

Volume:

Volume 34, Number 12

Publisher:

, Pages 107688-107688

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objective: We explored barriers to proper foot care in this population using a qualitative approach with focus group discussions (FGD). Methods: Participants were recruited from clinics at a safety-net hospital in Atlanta, Georgia and stratified into two groups: diabetic foot ulcer (DFU) and minor amputation (below ankle). The FGDs addressed patient experience in receiving care with a goal of understanding: foot care knowledge, barriers to care, and preferred educational methods. Surveys were performed to supplement FGDs. Results: Forty participants (90% Black) were enrolled. Dominant themes emerging from FGDs were: 1-Patients reported adequate understanding of recommended foot care practices; 2-Personal barriers to self-care included lack of motivation, high cost, poor insurance coverage of supplies, and difficulty limiting activity for proper offloading; 3-Hospital system barriers included difficulty making timely appointments and reaching a provider to arrange care; 4-Access to footcare-related information and services improved with greater disease severity. Participants stressed that improved access often came too late to alter their course. They expressed interest in developing peer support groups to facilitate learning and sharing information relating to DFU. Conclusion: We found that patients with DFU or minor amputations have adequate footcare-related knowledge, but personal and systemic barriers limited appropriate foot care.

Copyright information:

© 2020, Elsevier

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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