Fig 1. Depiction of the stages of delay and how themes identified fit into those stages.

This figure was adapted from Walter et al. [15] and conceptualizes delay intervals occurring between phases of decision-making. The appraisal interval describes the time from becoming aware of bodily change to perceiving a reason to discuss symptoms with a healthcare provider (HCP). During this appraisal interval, patients may self-manage their foot. The care-seeking interval is the time between perceiving a reason to discuss symptoms with a HCP and meeting with a HCP. The diagnosis interval is the time between meeting with a HCP and having a provider diagnose the foot as having an ulcer/gangrene/etc. The treatment interval is the time between when a diagnosis is made until treatment is initiated. Two of the patient factors identified occurred during the appraisal interval, while two others occurred during the care-seeking interval. “Asking patients to watch it”, a system-level factors impacted the appraisal interval because responsibility of evaluating worsening of symptoms was returned to the patient. Lack of timely access to care delayed care-seeking and diagnosis. Distance to care and other transportation barriers delayed care-seeking.