Influence of beliefs about health and illness on self-care and care-seeking in foreign-born people with diabetic foot ulcers: dissimilarities related to origin.
OBJECTIVE
To describe beliefs about health and illness among foreign-born people with diabetic foot ulcers that might affect self-reported self-care and health-care seeking and to study whether there are dissimilarities related to origin.


METHODS
Qualitative descriptive study. Semi-structured interviews with people aged 38-86 years; 13 born in European and 13 in non-European countries (all except one in the Middle East). All resident in Sweden for 7-60 years (median: 18.5 years).


RESULTS
Most believed foot ulcers were unavoidable and difficult to detect. Foot problems were mainly believed to be due to internal factors (diabetes), sometimes combined with external factors (inappropriate footwear, hot water, or barefoot walking). Health was described as freedom from illness and health professionals were seen as important sources of information. Perceived health deteriorated after the onset of the foot problems due to immobility and pain. People from the Middle East differed from other respondents as they discussed the importance of adapting to the will of Allah, leading to even poorer quality of life and a more negative view of future health. They also described more foot problems and perceived religion (Islam) with ritual washing of the feet to be important for health. However, they were regularly monitored to a lesser extent than European migrants. Economy affected health, more so in Europeans, due to expenses for medications and shoes. Many described limited activity in self-care, few had sought help for their problems and then solely among professionals, and had limited knowledge about the influence of glycaemic control on diabetes and foot status.


CONCLUSIONS
Foreign-born people felt unable to prevent the incidence of foot ulcers, experienced problems with detection, and had limited knowledge of self-care. Dissimilarities in beliefs related to origin negatively influenced self-care of the feet, so it is important to assess individual beliefs and plan care and education accordingly.
Department of Social and Welfare Studies, University of Linköping, Campus Norrköping, Sweden.
K
K
Hjelm
Department of Endocrinology, Skåne University Hospital, Malmö, Lund University, Sweden.
J
J
Apelqvist
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003466:Cultural Characteristics; D017719:Diabetic Foot / Q000628:therapy*; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012648:Self Care / Q000523:psychology*
Beliefs about health/illness; care-seeking behaviour; diabetes mellitus complications; foot ulcer; migrants; self-care