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


  • Tiwonge Chithambo
  • Angus Forbes




Care delivery, diabetes, diabetic foot, health behaviours, patient experience, qualitative study



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.


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Cheer K, Shearman C, Jude EB. Managing complications of the diabetic foot. BMJ. 2009;339:1304–7.

Jeffcoate WJ, Harding KG. 2003. Diabetic foot ulcers. The Lancet [online]. Available from: http://image.thelancet.com/extras/02art6190web.pdf [accessed 01 July 2012].

Muller IS, De Grauw WJC, van Gerwen WHEM, Bartelink ML, van den Hoogen HJM, Rutten GEHM. Foot ulceration and lower limb amputation in type 2 diabetic patients in Dutch primary health care. Diabet Care 2002;25(3);570–4.

van Battum P, Schaper N, Prompers L, Apelqvist J, Piaggesis A, Baker V, et al. Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease at presentation. Diabet Med. 2011;28:199–205.

O'Rouke IO, Heard S, Treacy J, Gruen R, Whitebread C. Risk to feet in the top end: outcomes of diabetic foot complications. ANZ J Surg. 2002;72:282–6.

Abbas Z, Lutale JK, Archibald LK. Clinical outcome of diabetes patients hospitalized with foot ulcers, Dar es Salaam, Tanzania. Diabet Med. 2002;19:575–9.

Gale L, Vedhara K, Searle A, Kemple T, Campbell R. Patients’ perspectives on foot complications in type 2 diabetes: a qualitative study. Br J Gen Pract. 2008;58(553):555–63.

Hjelm K, Nyberg P, Apelqvist J. The influence of beliefs about health and illness on foot care in diabetic subjects with severe foot lesions: a comparison of foreign and Swedish-born individuals. Clin Effect Nurs. 2003;7(1):3–14.

Wong M, Haswell-Elkins M, Tamwoy E, McDermott R, d'Abbs P. Perspectives on clinical attendance, medication and foot-care among people with diabetes in the Torres Strait Islands and Northern Peninsula Area. Aust J Rural Health 2005;13(3):172–7.

Smith JA. Qualitative psychology. London: Sage Publications; 2003.

Murry M, Chamberlain K. Qualitative health psychology. London: Sage Publications; 1999.

Smith JA, Flowers P, Larkin M. Interpretative phenomenological analysis: theory, method and research. London: SAGE Publications Ltd; 2009.

Reid K, Flowers P, Larkin M. Exploring lived experience: an introduction to interpretative phenomenological analysis. The Psychologist 2005;18:20–23.

Ballard K, Lowton K, Wright J. What's the delay? A qualitative study of women's experiences of reaching a diagnosis of endometriosis. Fertil Steril. 2006;86(5):1296–1301.

Burgess C, Hunter M, Ramirez AJ. A qualitative study of delay among women reporting symptoms of breast cancer. Br J Gen Pract. 2001;51(473):967–71.

Janson S, Becker G. Reasons for delay in seeking treatment for acute asthma: the patient's perspective. J Asthma 1998;35(5):427–35.

Macfarlane RM, Jeffcoate WJ. Factors contributing to the presentation of diabetic foot ulcers. Diabet Med. 1997;14(10):867–70.

Thomson FJ, Masson EA. Can elderly patients co-operate with routine foot care? Age Ageing 1992;21(5):333–7.

Crosland A, Jones R. Rectal bleeding: prevalence and consultation behaviour. BMJ. 1995;311:486–8.

Lydeard S, Jones R. Factors affecting the decision to consult with dyspepsia: comparison of consulters and non-consulters. J R Coll Gen Pract. 1989;39(329):495–8.

Sjöström-Strand A, Fridlund B. Women's descriptions of symptoms and delay reasons in seeking medical care at the time of a first myocardial infarction: a qualitative study. Int J Nurs Stud. 2007;45(7):1003–10.

Hjelm K, Beebwa E. The influence of beliefs about health and illness on foot care in Ugandan persons with diabetic foot ulcers. Open Nurs J., 2013;7:123–32 123.

Cornally N, McCarthy G. Help-seeking behaviour: a concept analysis. Int J Nurs Pract. 2011;17(3):280–8.

Jeffcoate WJ, van Houtum. Amputation as a marker of the quality of foot care in diabetes. Diabetologia 2004;47(12):2051–8.

Prompers L, Huijberts M, Apelqvist J, Judet E, Piaggesi A, Bakker K, et al. Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study. Diabet Med. 2008;25(60):700–7.




How to Cite

Chithambo, T., & Forbes, A. (2015). Exploring factors that contribute to delay in seeking help with diabetes related foot problems: a preliminary qualitative study using Interpretative Phenomenological Analysis. International Diabetes Nursing, 12(1), 20–26. https://doi.org/10.1179/2057331615Z.0000000006



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