The experience of foot problems and decisions to access foot care in patients with rheumatoid arthritis: a qualitative study

Abstract

BackgroundAlthough foot problems are common in rheumatoid arthritis (RA), the consequences of foot problems from the patient perspective have not been fully explored. The aims of this study were to explore the experience of foot problems and decisions to access foot care services or not in patients with RA.MethodsSemi structured, one-to-one interviews with patients recruited from 2 UK rheumatology units, purposively sampled for self-reported foot problems and a range of personal/disease characteristics. Inductive thematic analysis was used, with rigour provided by multiple independent analysers. Emerging themes were discussed and agreed by all authors.ResultsTwelve patients participated: 7 female; mean age 56 years (29–72); mean disease duration 12 years (2–27), 5 had accessed foot care services. The ‘Impact’ of foot problems was substantial and formed the underpinning theme, comprising three organising themes: ‘Foot symptoms’; ‘Consequences’; and ‘Cost’. Foot symptoms such as pain and numbness required self-management, and affected daily life (walking, working) leading to social and emotional costs. The global theme, ‘Decision to access foot care or not’, also comprised three organising themes: ‘Access perceived unnecessary’ (no problem, can cope); ‘Access hindered by patients’ perception’; and ‘Access supported by patient and clinician’. Decisions to access foot care or not were complex and influenced by patient beliefs regarding possible treatments and how to access these, and hindered by patient perceptions that their feet were ignored by rheumatology clinicians. Positive experience of foot care encouraged continued utilisation but negative experiences contributed to patients’ decisions to discontinue foot care services.ConclusionsFoot problems are important issues for patients and impact on many aspects of their physical, social and emotional lives. Patients who had accessed foot care services prioritised their foot problems as an important health care need. However, for others who would like foot care services, personal knowledge and values, and perceived barriers in clinical practice, appear to interact to inhibit foot care access. The extent which these interactions affect overall access to foot care in RA patients in general now needs to be quantified to help to inform and improve the effectiveness of the organisation and delivery of foot care.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-017-0188-3) contains supplementary material, which is available to authorized users.

Challenges of foot self‐care in older people: a qualitative focus‐group study

“…at school or, at the latest, during working life) to influence attitudes towards feet before any foot problems that affect functional ability or quality of life occur. This study supports the previous findings about health care professionals’ lack of attention to feet and foot problems [50]. There is a need to develop strategies and interventions increase knowledge of foot self-care and interest in feet.…”

Patient Work and Their Contexts: Scoping Review

“…Category 4 was the only category that explicitly described how patients changed their physical environment and tools. Tasks in this category (eg, use and maintain assistive devices [ 16 , 20 , 42 , 50 , 56 , 58 , 59 , 62 , 67 , 69 , 72 , 74 , 89 , 90 , 95 , 97 , 98 ], do-it-yourself symptom management tools [ 18 , 19 , 47 , 59 , 62 , 66 , 74 , 77 , 95 ], and alter the physical environment [ 46 , 62 , 93 ]) had an immediate physical return in the form of better tools or a more comfortable physical environment, with the tools ranging from day-to-day items (eg, shoe insoles [ 97 ]) to specialized equipment (such as home oxygen tanks [ 59 ]). Patients are very aware of how this category is an investment to improve the quality of life as well as what kind of support (mainly financial) is available from health organizations.…”

“…This category included tasks where patients sought help from other people, including seek medical help [ 2 , 14 , 18 , 40 , 41 , 44 , 49 - 52 , 58 , 65 , 75 , 79 , 80 , 83 , 89 , 93 , 96 , 97 ], ask for help from family and friends [ 18 , 40 , 46 , 47 , 50 , 51 , 57 , 60 , 63 , 67 , 69 , 73 , 77 , 93 , 95 , 98 ], hire professional help [ 20 , 43 , 52 , 69 , 95 , 98 ], and consult complementary therapy [ 58 , 59 , 64 , 66 , 84 ]. This category also included unplanned interactions, such as visits to the emergency department [ 41 , 89 ].…”

Prevalence, impact and care of foot problems in people with rheumatoid arthritis: results from a United Kingdom based cross‐sectional survey

“…It could be inferred that patients consider their foot problems to be an important health care need that they are willing to self-fund. Conversely, patients may elect to self-fund their foot care due to lack of NHS provided foot care, barriers to accessing care and/or experience of care received [ 22 ].…”

“…In order to establish the prevalence and impact of foot problems and access to foot care in patients with RA a survey is required of a large group of patients with RA, randomly selected from a defined population which has equitable access to both primary and secondary based foot care services and including assessment of the full range of impact. Here we report such a survey using an RA population-based sample in a well-defined geographical area to determine the prevalence of self-reported foot problems, assess their impact (based on previous qualitative work [ 22 ], identify the proportion of patients who have accessed foot care (podiatry, orthotics and/or orthopaedics) within the study geographical area.…”