Psychosocial markers of pre-hospital delay in patients with diabetic foot: A cross-sectional survey.
Huiwen Xu, Chen Wu, Shengxiao Xiang and 5 others
PMID 38268288WHAT IT FOUND
Most Chinese diabetic foot patients arrived at hospital at or after the first day of symptoms.
Less use of social support, seeing the illness as less serious, and more negative emotions were linked with longer delay.
Key findings
01Only 3 of 164 analysed patients arrived at hospital within 24 hours of diabetic foot symptoms; 161 arrived after 24 hours or more.
02In adjusted analysis, longer pre-hospital delay was associated with less use of social support, less negative illness perception and higher negative affectivity.
03The largest delay groups were 8 to 14 days (50 patients) and 15 to 30 days (58 patients).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was cross-sectional, so it could not show that psychosocial factors caused longer delay. Convenience sampling from two wound clinics in one urban area in China may limit generalisability. 18 of 182 enrolled patients could not recall the date the wound appeared and were excluded, leaving 164 analysed. Pre-hospital delay was based on patients' retrospective recall of symptom onset and hospital arrival, which may introduce memory bias. The study did not validate the questionnaires in this sample. No in-depth interviews were conducted, so the reasons patients gave for delay were not explored. Diabetes complications such as retinopathy and neuropathy may affect timely decisions but were not accounted for in the analysis.
Declared interests
The study was funded by Chinese government research programmes, including Yangzhou City, a Jiangsu Key Laboratory, the Ministry of Education Spring Sunshine Program and the Jiangsu Provincial Administration of Traditional Chinese Medicine. The authors declared no commercial or financial relationships that could be a conflict.
The easy way to misread this
Do not read the associations as proof that improving social support, illness perception or negative emotions will shorten diabetic foot delays. This was a cross-sectional survey with convenience sampling and retrospective self-report, so it identifies linked factors but does not test an intervention.