Delayed standard care in diabetic foot ulcers: the roles of initial response pathways and non-professional health information

Background 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. Objective 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. Methods 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 >7 days, clinical outcomes, and amputation concerns. Logistic regression estimated adjusted associations. Interviews with 16 purposively selected participants explained quantitative patterns, and findings were integrated. Results 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 1.07–3.85) and home-based or non-standard care (OR 4.61, 95% CI 2.35–9.04) were associated with delay; the information-exposure score was also associated (OR 1.59, 95% CI 1.30–1.94). Delay was associated with Wagner grade 3–5 disease (OR 2.18, 95% CI 1.43–3.32) and amputation (OR 1.85, 95% CI 1.11–3.08). 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 1.45–3.81). Interviews linked reduced urgency, competing information, self-treatment, and anticipated dependence or caregiving burden to these patterns. Conclusion 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.