792-P: Understanding Barriers to Diabetic Foot Care in an Urban Low-Income Hospital: A Focus Group Qualitative Assessment

Diabetes is a leading cause of lower limb loss in the United States that disproportionately affects minority groups of lower socioeconomic status. The reasons for these disparities are poorly characterized. We employed qualitative (focus group discussions, FGD) and quantitative (survey) methods among persons with diabetic foot disease. Participants were stratified into two groups: a diabetic foot ulcer (DFU) group and minor amputation (ankle or below) group. The FGDs addressed patient experience with a goal of understanding: (1) foot care knowledge, (2) barriers to care, and (3) preferred foot-related educational methods. 5 sessions were conducted with 6-12 people each. Participants were recruited from clinics at a safety-net hospital in Atlanta that provides care to an inner-city population with a high burden diabetic foot related complications. Forty participants (90% Black) were enrolled. Surveys revealed an adequate knowledge of proper diabetic foot care, with ≥70% of participants correctly answering questions relating to proper self-care. Several dominant themes emerged from the FGDs. Personal barriers to self-care included lack of motivation, difficulty accessing supplies due to cost and/or lack of insurance, and being unable to limit activity for proper offloading. Participants frequently reported systematic barriers, citing difficulty making timely appointments and reaching a provider to arrange care. Participants reported that foot-related knowledge and access to care improved with greater disease severity but that knowledge and interventions seemed to come too late in their disease course. They expressed interest in peer support groups to facilitate learning and sharing information about diabetic foot care. These findings indicate patients with DFU or minor amputations in our institution have adequate footcare-related knowledge, but barriers to care and lack of motivation limit appropriate foot care.