Identifying barriers to preventive care among First Nations people at risk of lower extremity amputation: a qualitative study
BACKGROUND: First Nations people in Canada are overrepresented among those who have undergone nontraumatic lower extremity amputation, and are more likely to be younger, have diabetic foot infections and have no previous revascularization procedures than non–First Nations populations who have underg...
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ftpubmed:oai:pubmedcentral.nih.gov:10569813 2023-11-12T04:17:08+01:00 Identifying barriers to preventive care among First Nations people at risk of lower extremity amputation: a qualitative study Wees, Tyrell Pandey, Mamata Nicolay, Susanne Windigo, Juandell Bitternose, Agnes Kopriva, David 2023-10-10 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10569813/ http://www.ncbi.nlm.nih.gov/pubmed/37816546 https://doi.org/10.9778/cmajo.20220150 en eng CMA Impact Inc. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10569813/ http://www.ncbi.nlm.nih.gov/pubmed/37816546 http://dx.doi.org/10.9778/cmajo.20220150 © 2023 CMA Impact Inc. or its licensors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/ CMAJ Open Research Text 2023 ftpubmed https://doi.org/10.9778/cmajo.20220150 2023-10-15T01:11:27Z BACKGROUND: First Nations people in Canada are overrepresented among those who have undergone nontraumatic lower extremity amputation, and are more likely to be younger, have diabetic foot infections and have no previous revascularization procedures than non–First Nations populations who have undergone lower extremity amputations. We sought to identify access barriers for high-risk First Nations patients, explore patients’ experiences with health care systems and identify solutions. METHODS: Employing a community participatory research design, we engaged representatives from 2 communities. They assisted with research design and data analysis, and approved the final manuscript. Using a hermeneutic phenomenological approach and purposeful sampling, we conducted 5 semistructured focus groups between August and December 2021 with community health care teams and patients at risk for, or who had previously undergone, a nontraumatic lower extremity amputation. RESULTS: Patients’ (n = 10) and community health care providers’ (n = 18) perspectives indicated that barriers to health care access led to delayed care and increased complications and risk for lower extremity amputations, leading to aggressive procedures upon receiving care. Barriers to care led to negative experiences at urban centres and aggressive procedures created further distrust, leading to care disengagement and poor outcomes. Patients and providers both suggested building stronger partnerships between urban and rural health care providers, improving education for patients and health care providers and identifying innovative strategies to improve patients’ overall health. INTERPRETATION: Systemic changes, health promotional program and reliable on-reserve primary care are needed to create equitable access for First Nation patients at risk for lower extremity amputations. The study results imply that health care delivery for First Nations patients at risk for lower extremity amputations can be improved through stronger partnership and communication ... Text First Nations PubMed Central (PMC) Canada CMAJ Open 11 5 E906 E914 |
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Research Wees, Tyrell Pandey, Mamata Nicolay, Susanne Windigo, Juandell Bitternose, Agnes Kopriva, David Identifying barriers to preventive care among First Nations people at risk of lower extremity amputation: a qualitative study |
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Research |
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BACKGROUND: First Nations people in Canada are overrepresented among those who have undergone nontraumatic lower extremity amputation, and are more likely to be younger, have diabetic foot infections and have no previous revascularization procedures than non–First Nations populations who have undergone lower extremity amputations. We sought to identify access barriers for high-risk First Nations patients, explore patients’ experiences with health care systems and identify solutions. METHODS: Employing a community participatory research design, we engaged representatives from 2 communities. They assisted with research design and data analysis, and approved the final manuscript. Using a hermeneutic phenomenological approach and purposeful sampling, we conducted 5 semistructured focus groups between August and December 2021 with community health care teams and patients at risk for, or who had previously undergone, a nontraumatic lower extremity amputation. RESULTS: Patients’ (n = 10) and community health care providers’ (n = 18) perspectives indicated that barriers to health care access led to delayed care and increased complications and risk for lower extremity amputations, leading to aggressive procedures upon receiving care. Barriers to care led to negative experiences at urban centres and aggressive procedures created further distrust, leading to care disengagement and poor outcomes. Patients and providers both suggested building stronger partnerships between urban and rural health care providers, improving education for patients and health care providers and identifying innovative strategies to improve patients’ overall health. INTERPRETATION: Systemic changes, health promotional program and reliable on-reserve primary care are needed to create equitable access for First Nation patients at risk for lower extremity amputations. The study results imply that health care delivery for First Nations patients at risk for lower extremity amputations can be improved through stronger partnership and communication ... |
format |
Text |
author |
Wees, Tyrell Pandey, Mamata Nicolay, Susanne Windigo, Juandell Bitternose, Agnes Kopriva, David |
author_facet |
Wees, Tyrell Pandey, Mamata Nicolay, Susanne Windigo, Juandell Bitternose, Agnes Kopriva, David |
author_sort |
Wees, Tyrell |
title |
Identifying barriers to preventive care among First Nations people at risk of lower extremity amputation: a qualitative study |
title_short |
Identifying barriers to preventive care among First Nations people at risk of lower extremity amputation: a qualitative study |
title_full |
Identifying barriers to preventive care among First Nations people at risk of lower extremity amputation: a qualitative study |
title_fullStr |
Identifying barriers to preventive care among First Nations people at risk of lower extremity amputation: a qualitative study |
title_full_unstemmed |
Identifying barriers to preventive care among First Nations people at risk of lower extremity amputation: a qualitative study |
title_sort |
identifying barriers to preventive care among first nations people at risk of lower extremity amputation: a qualitative study |
publisher |
CMA Impact Inc. |
publishDate |
2023 |
url |
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10569813/ http://www.ncbi.nlm.nih.gov/pubmed/37816546 https://doi.org/10.9778/cmajo.20220150 |
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Canada |
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Canada |
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First Nations |
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First Nations |
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CMAJ Open |
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10569813/ http://www.ncbi.nlm.nih.gov/pubmed/37816546 http://dx.doi.org/10.9778/cmajo.20220150 |
op_rights |
© 2023 CMA Impact Inc. or its licensors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/ |
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https://doi.org/10.9778/cmajo.20220150 |
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