La Trobe
journal.pone.0248310.pdf (568.24 kB)
Download file

How patients interpret early signs of foot problems and reasons for delays in care: Findings from interviews with patients who have undergone toe amputations

Download (568.24 kB)
journal contribution
posted on 2021-04-12, 04:55 authored by AJ Littman, J Young, M Moldestad, CL Tseng, JR Czerniecki, GJ Landry, J Robbins, EJ Boyko, Michael DillonMichael Dillon
Aims To describe how patients respond to early signs of foot problems and the factors that result in delays in care. Methods Semi-structured interviews were conducted with a large sample of Veterans from across the United States with diabetes mellitus who had undergone a toe amputation. Data were analyzed using inductive content analysis. Results We interviewed 61 male patients. Mean age was 66 years, 41% were married, and 37% had a high school education or less. The patient-level factors related to delayed care included: 1) not knowing something was wrong, 2) misinterpreting symptoms, 3) "sudden" and "unexpected" illness progression, and 4) competing priorities getting in the way of care-seeking. The system-level factors included: 5) asking patients to watch it, 6) difficulty getting the right type of care when needed, and 7) distance to care and other transportation barriers Conclusion A confluence of patient factors (e.g., not examining their feet regularly or thoroughly and/or not acting quickly when they noticed something was wrong) and system factors (e.g., absence of a mechanism to support patient s appraisal of symptoms, lack of access to timely and convenient-located appointments) delayed care. Identifying patient-and systemlevel interventions that can shorten or eliminate care delays could help reduce rates of limb loss.


Publication Date







3 March

Article Number



Public Library of Science (PLoS)



Rights Statement

The Author reserves all moral rights over the deposited text and must be credited if any re-use occurs. Documents deposited in OPAL are the Open Access versions of outputs published elsewhere. Changes resulting from the publishing process may therefore not be reflected in this document. The final published version may be obtained via the publisher’s DOI. Please note that additional copyright and access restrictions may apply to the published version.

Usage metrics