Patient-Perceived Barriers to Early Help-Seeking, Diagnosis, and Surgical Treatment for Rural Patients with Venous Leg Ulcers: A Qualitative Study

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.