{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:00:05Z","timestamp":1790316005787,"version":"4.1.0"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Delayed entry into standard diabetic foot care may reflect non-standard initial actions, inaccurate risk appraisal, and exposure to unreliable health information. Practical concerns about life after amputation may further postpone treatment decisions, but these modifiable processes remain insufficiently characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine initial response pathways, non-professional health information exposure, and post-amputation living-support concerns in relation to delayed care, disease severity, limb outcomes, and amputation decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single-center prospective explanatory mixed-methods study included 400 adults with diabetic foot ulcers from August 2024 to February 2026. Questionnaires and records assessed response pathways, information exposure, delay &amp;gt;7\u202fdays, clinical outcomes, and amputation concerns. Logistic regression estimated adjusted associations. Interviews with 16 purposively selected participants explained quantitative patterns, and findings were integrated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Delayed care occurred in 215 patients (53.8%), and 206 (51.5%) reported non-professional information exposure. Relative to direct standard care, non-specialist care (OR 2.03, 95% CI 1.07\u20133.85) and home-based or non-standard care (OR 4.61, 95% CI 2.35\u20139.04) were associated with delay; the information-exposure score was also associated (OR 1.59, 95% CI 1.30\u20131.94). Delay was associated with Wagner grade 3\u20135 disease (OR 2.18, 95% CI 1.43\u20133.32) and amputation (OR 1.85, 95% CI 1.11\u20133.08). Among 102 amputated patients with complete decision data, 54 (52.9%) delayed the decision; living-support concerns were associated with delay (OR 2.35, 95% CI 1.45\u20133.81). Interviews linked reduced urgency, competing information, self-treatment, and anticipated dependence or caregiving burden to these patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Delayed care reflected risk under-recognition, non-standard action, and competing information rather than inaction. Warning-sign education, service guidance, critical appraisal of health information, and structured amputation decision support may improve timely care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1905489","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:33:24Z","timestamp":1790314404000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Delayed standard care in diabetic foot ulcers: the roles of initial response pathways and non-professional health information"],"prefix":"10.3389","volume":"14","author":[{"given":"Wei","family":"Shan","sequence":"first","affiliation":[{"name":"Department of Interventional Vascular Surgery, General Hospital of Northern Theater Command","place":["Shenyang, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Interventional Vascular Surgery, General Hospital of Northern Theater Command","place":["Shenyang, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Qiao","sequence":"additional","affiliation":[{"name":"Department of Interventional Vascular Surgery, General Hospital of Northern Theater Command","place":["Shenyang, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Interventional Vascular Surgery, General Hospital of Northern Theater Command","place":["Shenyang, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Interventional Vascular Surgery, General Hospital of Northern Theater Command","place":["Shenyang, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1001\/jama.2023.10578","article-title":"Diabetic foot ulcers: a review","volume":"330","author":"Armstrong","year":"2023","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e3657","DOI":"10.1002\/dmrr.3657","article-title":"Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update)","volume":"40","author":"Schaper","year":"2024","journal-title":"Diabetes Metab Res Rev"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1080\/07853890.2016.1231932","article-title":"Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis","volume":"49","author":"Zhang","year":"2017","journal-title":"Ann Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"645","DOI":"10.2337\/dc17-1836","article-title":"Current challenges and opportunities in the prevention and management of diabetic foot ulcers","volume":"41","author":"Jeffcoate","year":"2018","journal-title":"Diabetes Care"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e3651","DOI":"10.1002\/dmrr.3651","article-title":"Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update)","volume":"40","author":"Bus","year":"2024","journal-title":"Diabetes Metab Res Rev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"ciad527","DOI":"10.1093\/cid\/ciad527","article-title":"IWGDF\/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF\/IDSA 2023)","author":"Senneville","year":"2023","journal-title":"Clin Infect Dis"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1016\/j.jvs.2023.07.020","article-title":"The 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Policy"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e296","DOI":"10.1371\/journal.pmed.0040296","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement","volume":"4","author":"von Elm","year":"2007","journal-title":"PLoS Med"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist","volume":"19","author":"Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"2134","DOI":"10.1111\/1475-6773.12117","article-title":"Achieving integration in mixed methods designs-principles and practices","volume":"48","author":"Fetters","year":"2013","journal-title":"Health Serv Res"},{"key":"ref39","volume-title":"Diabetic foot Problems: Prevention and Management (NG19)","year":"2015"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1007\/s00125-006-0491-1","article-title":"High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe: baseline results from the Eurodiale study","volume":"50","author":"Prompers","year":"2007","journal-title":"Diabetologia"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1111\/dme.12388","article-title":"Pre-hospital delay in patients with diabetic foot problems: influencing factors and subsequent quality of care","volume":"31","author":"Yan","year":"2014","journal-title":"Diabet Med"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1860867","DOI":"10.3389\/fendo.2026.1860867","article-title":"Pre-hospital delay >7 days independently predicts impaired wound healing in diabetic foot ulcer patients: a 3-year retrospective cohort study","volume":"17","author":"Zhang","year":"2026","journal-title":"Front Endocrinol"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1016\/j.jtv.2024.04.007","article-title":"Identification, influencing factors and outcomes of time delays in the management pathway of diabetic foot: a systematic review","volume":"33","author":"Li","year":"2024","journal-title":"J Tissue Viability"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"186","DOI":"10.12968\/jowc.2018.27.3.186","article-title":"Delayed referral of patients with diabetic foot ulcers across Europe: patterns between primary care and specialised units","volume":"27","author":"Manu","year":"2018","journal-title":"J Wound Care"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1177\/109019818801500203","article-title":"Social learning theory and the health belief model","volume":"15","author":"Rosenstock","year":"1988","journal-title":"Health Educ 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