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

J Diabetes Complications. 2020 Dec;34(12):107688. doi: 10.1016/j.jdiacomp.2020.107688. Epub 2020 Jul 23.


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.

Keywords: Barriers to care; Complications of diabetes; Diabetic foot complications; Diabetic foot education.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amputation
  • Diabetes Mellitus
  • Diabetic Foot* / epidemiology
  • Diabetic Foot* / therapy
  • Focus Groups
  • Georgia
  • Health Knowledge, Attitudes, Practice*
  • Health Services Accessibility*
  • Humans
  • Motivation
  • Safety-net Providers
  • Self Care
  • Vulnerable Populations*