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已发表论文
农村静脉性腿部溃疡患者对早期求助、诊断和手术治疗障碍的感知：一项定性研究
Authors Yu Y, Huang K, Wu J , Ding C, Zhang H
Received 12 September 2025
Accepted for publication 3 February 2026
Published 12 February 2026 Volume 2026:19 564545
DOI https://doi.org/10.2147/IJGM.S564545
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Kenneth Adler
Yingxia Yu,1,* Kanghui Huang,1,* Jingjin Wu,2 Caiyou Ding,2 Huafang Zhang1
1Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, Zhejiang, People’s Republic of China; 2Department of Vascular Surgery, Center for General Surgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, Zhejiang, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Huafang Zhang, Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, Zhejiang, People’s Republic of China, Email wuyizhangyichi@zju.edu.cn
Purpose: This qualitative study aimed to explore the patient-perceived barriers to early help-seeking, diagnosis, and surgical treatment among rural patients with venous leg ulcers.
Methods: Semi-structured face-to-face interviews were conducted with 16 rural patients with venous leg ulcers who underwent primary varicose vein surgery for the first time. The data were analyzed inductively and in accordance with reflexive thematic analysis. The generated themes were systematically mapped onto the corresponding intervals of the Model of Pathways to Treatment.
Results: We identified 11 barrier themes across the four intervals. During the symptom appraisal interval, barriers were symptom normalization, self-treatment, and avoidant coping with symptoms. When seeking help, patients faced disease misattribution, reliance on familial support and decision-making, and low public awareness of vascular surgery. The diagnosis interval was plagued by misdiagnosis or missed diagnosis and delayed specialist referrals. Finally, pre-surgery barriers included emotional and cognitive resistance to surgery, peer influence bias, and disparities in medical resources distribution.
Conclusion: This study identified diverse barriers across four stages of the treatment pathway for venous leg ulcers among rural patients, which were associated with disease-related, patient-related, and healthcare system-related factors. To address these barriers, a multifaceted healthcare system approach is essential, including enhanced public education, the implementation of age-friendly services, the establishment of evidence-based referral criteria, strengthened primary care competencies, and an expanded vascular surgery workforce to serve underserved areas.
Keywords: varicose ulcer, help-seeking behavior, primary health care, rural health
1Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, Zhejiang, People’s Republic of China; 2Department of Vascular Surgery, Center for General Surgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, Zhejiang, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Huafang Zhang, Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, Zhejiang, People’s Republic of China, Email wuyizhangyichi@zju.edu.cn
Purpose: This qualitative study aimed to explore the patient-perceived barriers to early help-seeking, diagnosis, and surgical treatment among rural patients with venous leg ulcers.
Methods: Semi-structured face-to-face interviews were conducted with 16 rural patients with venous leg ulcers who underwent primary varicose vein surgery for the first time. The data were analyzed inductively and in accordance with reflexive thematic analysis. The generated themes were systematically mapped onto the corresponding intervals of the Model of Pathways to Treatment.
Results: We identified 11 barrier themes across the four intervals. During the symptom appraisal interval, barriers were symptom normalization, self-treatment, and avoidant coping with symptoms. When seeking help, patients faced disease misattribution, reliance on familial support and decision-making, and low public awareness of vascular surgery. The diagnosis interval was plagued by misdiagnosis or missed diagnosis and delayed specialist referrals. Finally, pre-surgery barriers included emotional and cognitive resistance to surgery, peer influence bias, and disparities in medical resources distribution.
Conclusion: This study identified diverse barriers across four stages of the treatment pathway for venous leg ulcers among rural patients, which were associated with disease-related, patient-related, and healthcare system-related factors. To address these barriers, a multifaceted healthcare system approach is essential, including enhanced public education, the implementation of age-friendly services, the establishment of evidence-based referral criteria, strengthened primary care competencies, and an expanded vascular surgery workforce to serve underserved areas.
Keywords: varicose ulcer, help-seeking behavior, primary health care, rural health