Patient perceptions of barriers to attending annual diabetes review and foot assessment in general practice: a qualitative study

Introduction Regular diabetic foot checks, at least annually, are important for early identification of risk factors and prevention of ulceration and amputation. To ensure this, most general practices in Aotearoa New Zealand (NZ) offer free annual diabetes reviews (ADRs) which include a comprehensive foot evaluation. However, attendance rates at these ADRs are low.Aim To explore patients' perspectives on the barriers to attending ADRs and foot checks.Methods Semi-structured interviews with people with type 2 diabetes who were overdue their ADR (n = 13; 7 women, 6 Maori) from two urban practices were conducted. Interviews were audio recorded and transcribed verbatim and then analysed using an inductive thematic analysis approach.Results We identified three key themes demonstrating barriers to attendance: healthcare-associated factors (suboptimal clinician-patient relationship, not having a consistent general practitioner (GP)); patient-related factors (co-morbid health conditions, issues surrounding identity, and logistical issues); and systemic factors (COVID-19 pandemic, travel distance to the practice, unawareness of available foot care services). Participants' feedback focused on patient-centred approaches for improvements to service delivery, for example using online educational materials, and utilising culturally appropriate models of health including Te Whare Tapa Wha and Whanau Ora approach.Discussion We identified several barriers to attendance, some of which are potentially modifiable. Addressing modifiable barriers and incorporating suggestions made by participants may improve access to the ADR and reduce non-attendance. Further participatory action research could explore these insights in ways that facilitate tino rangatiratanga (self-determination) and palpable action. What is already known: Diabetes-related foot problems affect around one-third of people with diabetes in New Zealand. Early identification of the at-risk patient is crucial in the prevention of diabetic foot ulcers. Annual diabetes reviews (ADRs) delivered by general practice teams that include a comprehensive foot evaluation and risk categorisation are recommended by local and international guidelines.What this study adds: People with type 2 diabetes identified important barriers to attending ADRs several of which are amenable to change. Participants provided suggestions on how to improve the delivery of the ADR in primary care, including the utilisation of Maori tailored models of care such as the Te Whare Tapa Wha model and Maori support workers.