{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T05:51:01Z","timestamp":1784181061182,"version":"3.55.0"},"reference-count":66,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>For persons at risk for and experiencing amputations, accessible and cost-effective healthcare plays an essential role in prevention and rehabilitation. In Trinidad and Tobago, amputations continue to rise, despite the national healthcare system\u2019s attention to prevention, making the country a relevant case for providing insights into experiences of amputations within a healthcare system. The study used a basic interpretive, qualitative design with interviews conducted with 17 persons with lower-limb amputations and 17 relatives across Trinidad and Tobago. Thematic analysis revealed five themes related to the experiences of persons with amputations and their relatives within the healthcare system: a) care prior to amputation reflected missed opportunities for prevention; b) hospital circumstances compounded participants\u2019 experiences; c) post-amputation services hindered rehabilitation and ability of relatives to provide effective care; d) integrated services could promote wellbeing of persons with amputations and their relatives; and e) advocacy is necessary but complicated. Holistic, multidisciplinary care would benefit persons with amputations and their relatives, ultimately reducing burden on the healthcare system by contributing to improved health outcomes and quality of life. Recommendations regarding public health and rehabilitation, including considerations for culturally competent healthcare, are discussed.<\/jats:p>","DOI":"10.1371\/journal.pgph.0004739","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T17:28:45Z","timestamp":1750267725000},"page":"e0004739","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pre- and post-amputation healthcare experiences among persons with lower-limb amputations and their relatives: The case of Trinidad and Tobago"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3682-2626","authenticated-orcid":true,"given":"Bephyer","family":"Parey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleem","family":"Varachhia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Enightoola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4609-1601","authenticated-orcid":true,"given":"Elisabeth","family":"Kutscher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"key":"pgph.0004739.ref001","volume-title":"WHO global disability action plan 2014-2021: Better health for all people with disability","author":"World Health Organization","year":"2015"},{"key":"pgph.0004739.ref002","author":"United Nations","year":"2023"},{"key":"pgph.0004739.ref003","doi-asserted-by":"crossref","first-page":"110194","DOI":"10.1016\/j.diabres.2022.110194","article-title":"Global estimates of diabetes-related amputations incidence in 2010-2020: a systematic review and meta-analysis","volume":"195","author":"Y Ezzatvar","year":"2023","journal-title":"Diabetes Res Clin Pract"},{"issue":"2","key":"pgph.0004739.ref004","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s00125-022-05845-9","article-title":"Global trends in the incidence of hospital admissions for diabetes-related foot disease and amputations: a review of national rates in the 21st century","volume":"66","author":"PA Lazzarini","year":"2023","journal-title":"Diabetologia"},{"key":"pgph.0004739.ref005","first-page":"59","article-title":"More Than SF-36? Using narratives to elaborate health and well-being data in recent lower-limb amputees.","volume-title":"Quality of Life and the Millennium Challenge","author":"N Warren","year":"2008"},{"issue":"9","key":"pgph.0004739.ref006","doi-asserted-by":"crossref","DOI":"10.33425\/2639-944X.1233","article-title":"Traditional methods of health education are not enough to reduce major lower limb amputations in Trinidad & Tobago; a seven year retrospective study","volume":"5","author":"S Islam","year":"2021","journal-title":"J Med Clin Res Rev"},{"issue":"3","key":"pgph.0004739.ref007","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1046\/j.1365-2168.2000.01344.x","article-title":"Epidemiology of lower extremity amputation in centres in Europe, North America and East Asia","volume":"87","author":"N Unwin","year":"2000","journal-title":"Br J Surg"},{"issue":"8","key":"pgph.0004739.ref008","article-title":"Major lower limb amputations: recognizing pitfalls","volume":"13","author":"L Pran","year":"2021","journal-title":"Cureus"},{"key":"pgph.0004739.ref009","author":"Ministry of Health","year":"2017"},{"issue":"6","key":"pgph.0004739.ref010","first-page":"526","article-title":"The healthcare network to the amputee","volume":"27","author":"MA De Oliveira Vargas","year":"2014","journal-title":"Acta Paulista de Enfermagem"},{"issue":"11","key":"pgph.0004739.ref011","article-title":"The psychosocial impact of lower limb amputation on patients and caregivers","volume":"14","author":"M Alessa","year":"2022","journal-title":"Cureus"},{"issue":"1","key":"pgph.0004739.ref012","doi-asserted-by":"crossref","first-page":"12559","DOI":"10.1038\/s41598-021-91954-1","article-title":"Quality of life, body image and self-esteem in patients with unilateral transtibial amputations","volume":"11","author":"N Sarroca","year":"2021","journal-title":"Sci Rep"},{"issue":"1","key":"pgph.0004739.ref013","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1053\/j.semvascsurg.2021.02.011","article-title":"The epidemiology of lower extremity amputations, strategies for amputation prevention, and the importance of patient-centered care","volume":"34","author":"J Bernatchez","year":"2021","journal-title":"Semin Vasc Surg"},{"issue":"09","key":"pgph.0004739.ref014","first-page":"13722","article-title":"The knowledge, attitude, and practice of diabetic patients at a tertiary hospital in an eastern Caribbean nation - a cross-sectional study","volume":"12","author":"S Islam","year":"2020","journal-title":"Int J Curr Res"},{"key":"pgph.0004739.ref015","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1186\/s12913-015-1066-y","article-title":"Barriers to optimal diabetes care in Trinidad and Tobago: a health care Professionals\u2019 perspective","volume":"15","author":"N Roopnarinesingh","year":"2015","journal-title":"BMC Health Serv Res"},{"issue":"5","key":"pgph.0004739.ref016","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0000446","article-title":"Heterogeneity in the guidelines for the management of diabetic foot disease in the Caribbean","volume":"2","author":"BE Sumpio","year":"2022","journal-title":"PLOS Glob Public Health"},{"key":"pgph.0004739.ref017","author":"Y Rolston","year":"2014"},{"key":"pgph.0004739.ref018","doi-asserted-by":"crossref","first-page":"239","DOI":"10.2147\/RMHP.S72236","article-title":"Adverse events in diabetic foot infections: a case control study comparing early versus delayed medical treatment after home remedies","volume":"7","author":"SO Cawich","year":"2014","journal-title":"Risk Manag Healthc Policy"},{"key":"pgph.0004739.ref019","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/S0749-3797(02)00657-8","article-title":"Culturally competent healthcare systems. A systematic review","volume":"24","author":"Task Force on Community Preventive Services","year":"2003","journal-title":"Am J Prev Med"},{"issue":"7","key":"pgph.0004739.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0219971","article-title":"Culturally competent healthcare - a scoping review of strategies implemented in healthcare organizations and a model of culturally competent healthcare provision","volume":"14","author":"O Handtke","year":"2019","journal-title":"PLoS One"},{"issue":"1","key":"pgph.0004739.ref021","first-page":"49","article-title":"Practicing cultural competence and cultural humility in the care of diverse patients","volume":"18","author":"DE Stubbe","year":"2020","journal-title":"Focus (Am Psychiatr Publ)"},{"issue":"1","key":"pgph.0004739.ref022","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1089\/heq.2023.0226","article-title":"Past is prologue: dismantling colonial legacies to advance black health equity in the United States","volume":"7","author":"SM Alang","year":"2023","journal-title":"Health Equity"},{"issue":"9","key":"pgph.0004739.ref023","article-title":"Living with amputation: anxiety and depression correlates","volume":"10","author":"S Bhutani","year":"2016","journal-title":"J Clin Diagn Res"},{"key":"pgph.0004739.ref024","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/978-1-84628-980-4_2","article-title":"Coping and psychosocial adjustment to amputation.","volume-title":"Psychoprosthetics","author":"D Desmond","year":"2008"},{"issue":"5","key":"pgph.0004739.ref025","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1080\/17483107.2019.1602853","article-title":"Psychosocial and physical adjustments and prosthesis satisfaction in amputees: a systematic review of observational studies","volume":"15","author":"LP Luza","year":"2020","journal-title":"Disabil Rehabil Assist Technol"},{"issue":"3","key":"pgph.0004739.ref026","first-page":"320","article-title":"Lived experience of children and adolescents with lower-limb loss who used a prosthesis: a qualitative study","volume":"48","author":"S Chami","year":"2024","journal-title":"Prosthet Orthot Int"},{"issue":"1","key":"pgph.0004739.ref027","doi-asserted-by":"crossref","first-page":"4","DOI":"10.4103\/0972-6748.196041","article-title":"Psychological effects of amputation: a review of studies from India","volume":"25","author":"A Sahu","year":"2016","journal-title":"Ind Psychiatry J"},{"issue":"8","key":"pgph.0004739.ref028","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1177\/0269215507077361","article-title":"The rapid resolution of depression and anxiety symptoms after lower limb amputation","volume":"21","author":"R Singh","year":"2007","journal-title":"Clin Rehabil"},{"issue":"1","key":"pgph.0004739.ref029","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1177\/0309364611428662","article-title":"Is occupational therapy practice for older adults with lower limb amputations evidence-based? A systematic review","volume":"36","author":"G Spiliotopoulou","year":"2012","journal-title":"Prosthet Orthot Int"},{"issue":"2","key":"pgph.0004739.ref030","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1097\/PXR.0000000000000256","article-title":"Barriers and facilitators of receiving prosthetic services in people with lower limb amputation during Covid-19 pandemic: a qualitative study in a developing country","volume":"48","author":"S Nabizadeh","year":"2024","journal-title":"Prosthet Orthot Int"},{"issue":"3","key":"pgph.0004739.ref031","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/00008526-200209000-00003","article-title":"How does counseling help people with amputation?","volume":"14","author":"EM Price","year":"2002","journal-title":"J Prosthet Orthot"},{"issue":"11","key":"pgph.0004739.ref032","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1080\/09593985.2018.1425938","article-title":"A systematic literature review of physiotherapy and rehabilitation approaches to lower-limb amputation","volume":"34","author":"\u00d6 \u00dclger","year":"2018","journal-title":"Physiother Theory Pract"},{"issue":"6","key":"pgph.0004739.ref033","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1177\/0309364617690394","article-title":"Factors influencing quality of life following lower limb amputation for peripheral arterial occlusive disease: a systematic review of the literature","volume":"41","author":"F Davie-Smith","year":"2017","journal-title":"Prosthet Orthot Int"},{"issue":"9","key":"pgph.0004739.ref034","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.2522\/ptj.20120415","article-title":"Factors associated with utilization of preoperative and postoperative rehabilitation services by patients with amputation in the VA system: an observational study","volume":"93","author":"LJ Resnik","year":"2013","journal-title":"Phys Ther"},{"issue":"1","key":"pgph.0004739.ref035","article-title":"The effect of educational counselling on the knowledge of the amputee in using and caring the prosthesis","volume":"2","author":"B Mughnie","year":"2019","journal-title":"Urban Health"},{"issue":"5","key":"pgph.0004739.ref036","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1093\/ptj\/pzaa008","article-title":"Effectiveness of an evidence-based amputee rehabilitation program: a pilot randomized controlled trial","volume":"100","author":"R Gailey","year":"2020","journal-title":"Phys Ther"},{"issue":"1","key":"pgph.0004739.ref037","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1177\/0309364610397087","article-title":"Factors affecting quality of life in lower limb amputees","volume":"35","author":"R Sinha","year":"2011","journal-title":"Prosthet Orthot Int"},{"issue":"3","key":"pgph.0004739.ref038","doi-asserted-by":"crossref","first-page":"83","DOI":"10.11648\/j.wjph.20180303.13","article-title":"Health equity and access to health care in Trinidad and Tobago","volume":"3","author":"M Bahall","year":"2018","journal-title":"World J Public Health"},{"issue":"4","key":"pgph.0004739.ref039","first-page":"434","article-title":"Is physical rehabilitation need associated with the rehabilitation workforce supply? an ecological study across 35 high-income countries","volume":"11","author":"TS Jesus","year":"2022","journal-title":"Int J Health Policy Manag"},{"key":"pgph.0004739.ref040","doi-asserted-by":"crossref","first-page":"9970566","DOI":"10.1155\/2021\/9970566","article-title":"Identifying occupational therapy research priorities in Trinidad and Tobago: a group concept mapping study","volume":"2021","author":"S Murray-Mendes","year":"2021","journal-title":"Occup Ther Int"},{"issue":"8","key":"pgph.0004739.ref041","article-title":"Quality of life experienced by major lower extremity amputees","volume":"13","author":"L Pran","year":"2021","journal-title":"Cureus"},{"key":"pgph.0004739.ref042","author":"The Joint Select Committee on Social Services and Public Administration","year":"2018"},{"key":"pgph.0004739.ref043","first-page":"259","article-title":"Psychology in Guyana and Trinidad and Tobago.","volume-title":"Psychology in Oceania and the Caribbean","author":"JL Roopnarine","year":"2022"},{"issue":"66","key":"pgph.0004739.ref044","first-page":"47","article-title":"Family support and psychological equilibrium of patients with limb amputation","volume":"46","author":"S Ali","year":"2015","journal-title":"J Law Soc"},{"issue":"4","key":"pgph.0004739.ref045","doi-asserted-by":"crossref","first-page":"326","DOI":"10.3390\/bs14040326","article-title":"Needs of family caregivers of people with lower limb amputations: a scoping review","volume":"14","author":"D Rodrigues","year":"2024","journal-title":"Behav Sci (Basel)"},{"issue":"1","key":"pgph.0004739.ref046","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1177\/0950017016682458","article-title":"The health and well-being at work agenda: good news for (disabled) workers or just a capital idea?","volume":"32","author":"D Foster","year":"2017","journal-title":"Work Employment Soc"},{"issue":"11","key":"pgph.0004739.ref047","doi-asserted-by":"crossref","first-page":"2936","DOI":"10.1080\/09687599.2023.2233682","article-title":"From the equal opportunity commission case files: experiences among persons with disabilities in Trinidad and Tobago","volume":"39","author":"B Parey","year":"2023","journal-title":"Disab Soc"},{"issue":"7","key":"pgph.0004739.ref048","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1097\/00001888-200507000-00019","article-title":"Considering the culture of disability in cultural competence education","volume":"80","author":"GE Eddey","year":"2005","journal-title":"Acad Med"},{"issue":"5","key":"pgph.0004739.ref049","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1002\/pchj.341","article-title":"Burden and quality of life in caregivers of patients with amputated diabetic foot","volume":"9","author":"S Costa","year":"2020","journal-title":"Psych J"},{"issue":"6","key":"pgph.0004739.ref050","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1177\/0192513X211029248","article-title":"Attitudes towards home care of older persons with disabilities: the case of Trinidad","volume":"43","author":"B Parey","year":"2021","journal-title":"J Fam Issues"},{"issue":"2","key":"pgph.0004739.ref051","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/s12126-022-09490-w","article-title":"Measurement, associated factors, and gender implications of care views towards older persons with disabilities: the case of Trinidad","volume":"48","author":"B Parey","year":"2022","journal-title":"Ageing Int"},{"issue":"1","key":"pgph.0004739.ref052","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1332\/23978821Y2023D000000017","article-title":"Potential of carers to meet care needs among older adults with disabilities in Trinidad","volume":"8","author":"B Parey","year":"2024","journal-title":"Int J Care Caring"},{"issue":"5","key":"pgph.0004739.ref053","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s10488-013-0528-y","article-title":"Purposeful sampling for qualitative data collection and analysis in mixed method implementation research","volume":"42","author":"LA Palinkas","year":"2015","journal-title":"Adm Policy Ment Health"},{"key":"pgph.0004739.ref054","volume-title":"Qualitative research & evaluation methods: Integrating theory and practice","author":"MQ Patton","year":"2014"},{"issue":"2","key":"pgph.0004739.ref055","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1177\/1468794112446106","article-title":"\u2018Unsatisfactory Saturation\u2019: a critical exploration of the notion of saturated sample sizes in qualitative research","volume":"13","author":"M O\u2019Reilly","year":"2012","journal-title":"Qual Res"},{"key":"pgph.0004739.ref056","volume-title":"Qualitative Research in Practice: Examples for Discussion and Analysis","author":"SB Merriam","year":"2002"},{"key":"pgph.0004739.ref057","first-page":"195","article-title":"Paradigmatic controversies, contradictions, and emerging confluences.","volume-title":"The SAGE Handbook of Qualitative Research","author":"EG Guba","year":"2005"},{"issue":"4","key":"pgph.0004739.ref058","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1037\/1045-3830.22.4.557","article-title":"An array of qualitative data analysis tools: a call for data analysis triangulation","volume":"22","author":"NL Leech","year":"2007","journal-title":"School Psychol Quarterly"},{"key":"pgph.0004739.ref059","volume-title":"Qualitative Research and Case Study Applications in Education: Revised and Expanded from Case Study Research in Education","author":"SB Merriam","year":"1998"},{"issue":"3","key":"pgph.0004739.ref060","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1177\/10497323211059151","article-title":"Healthcare barriers among working-age persons with disabilities in Trinidad","volume":"32","author":"B Parey","year":"2022","journal-title":"Qual Health Res"},{"key":"pgph.0004739.ref061","author":"World Health Organization.","year":"2025"},{"issue":"3","key":"pgph.0004739.ref062","doi-asserted-by":"crossref","first-page":"229","DOI":"10.4103\/0973-1075.138401","article-title":"The perception of trauma patients from social support in adjustment to lower-limb amputation: a qualitative study","volume":"20","author":"S Valizadeh","year":"2014","journal-title":"Indian J Palliat Care"},{"issue":"2","key":"pgph.0004739.ref063","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0002867","article-title":"Interdisciplinary perspectives on digital technologies for global mental health","volume":"4","author":"E Kuhn","year":"2024","journal-title":"PLOS Glob Public Health"},{"issue":"9","key":"pgph.0004739.ref064","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0002292","article-title":"Diabetes health care specific services readiness and availability in Kenya: Implications for Universal Health Coverage","volume":"3","author":"SN Onteri","year":"2023","journal-title":"PLOS Glob Public Health"},{"issue":"7","key":"pgph.0004739.ref065","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1016\/j.pec.2020.02.017","article-title":"Empowerment in healthcare: a thematic synthesis and critical discussion of concept analyses of empowerment","volume":"103","author":"K Halvorsen","year":"2020","journal-title":"Patient Educ Couns"},{"issue":"8","key":"pgph.0004739.ref066","doi-asserted-by":"crossref","first-page":"563","DOI":"10.2471\/BLT.18.225201","article-title":"When the patient is the expert: measuring patient experience and satisfaction with care","volume":"97","author":"E Larson","year":"2019","journal-title":"Bull World Health Organ"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0004739","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T17:28:58Z","timestamp":1750267738000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0004739"}},"subtitle":[],"editor":[{"given":"Julia","family":"Robinson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,6,18]]},"references-count":66,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0004739","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,18]]}}}