Article
“Standing still in the street”: Experiences, knowledge and beliefs of patients with intermittent claudication—A qualitative study

https://doi.org/10.1016/j.jvn.2014.12.001Get rights and content

Objectives

To explore the experiences of individuals living with intermittent claudication (IC) owing to peripheral artery disease (PAD), their knowledge about the condition, and their thoughts about being asked to walk more and an intervention to promote walking.

Methods

We conducted five focus group sessions with 24 people (71% male; mean age, 71 years) diagnosed with IC with no prior lower extremity revascularization.

Results

Two overriding themes emerged: uncertainty and lack of support/empathy. Participants expressed uncertainty about PAD and IC, how risk factors work, and whether lifestyle change, particularly walking, would help. They also expressed dissatisfaction with and lack of empathy from the medical professionals encountered, with feelings of being dismissed and left on their own. There was enthusiasm for an education program to support their self-management of the disease.

Conclusions

Addressing the knowledge gaps and uncertainty around the disease process and walking will be critical to providing impetus to behavior change. A structured education approach to address these issues seems to be desirable and acceptable to those living with PAD.

Practice implications

Those working with PAD patients should provide clear and consistent information about the disease process and specific information on walking, as well as support to enable and manage behavior change.

Section snippets

Design

This study adopted a qualitative approach, and utilized a focus group methodology to explore patients' perceptions.

Sample

Twenty-four patients with IC owing to PAD were recruited via screening vascular clinic letters at a hospital in the midlands in the United Kingdom. Participants took part in one of five focus groups. The groups were 71% male and 100% White British, with a mean age of 71 years (SD = 8) and a median duration of claudication symptoms of 17.5 months (range, 3-180 months).

Inclusion

Results

The data presented herein illustrate the main themes arising from the analysis with overriding themes of uncertainty and lack of support/empathy pervading all of these. There was uncertainty about PAD and IC, uncertainty about how risk factors work, and uncertainty about whether lifestyle change, particularly physical activity, would help. There was a strong sense of dissatisfaction with and lack of empathy from the medical professionals encountered with a feeling of being dismissed, being left

Discussion

This qualitative study provides insight into the experiences and knowledge of individuals with PAD and their perceptions on a proposed structured education intervention to promote walking. Consistent with Egberg et al,24 PAD had a significant impact on the lives of the participants and resulted in a curtailing of activities and a loss of enjoyment. Although the participants had some understanding about the condition, they expressed a degree of uncertainty around the specifics of the condition

Conclusion

Participants with PAD emphasize uncertainty about the disease and the role that walking may play in its management. They express uncertainty about how much walking, and with what level of pain, is required to achieve benefits. Addressing patient's knowledge gaps and uncertainty around the disease process and walking will be critical to providing impetus to behavior change. This study provides evidence to inform the development of an educational intervention to address these issues. Such an

Practice implications

From our findings, the following may be considered:

  • Provide a treatment and management plan at the point of diagnosis.

  • Written information about the condition to take away, in conjunction with ongoing support, is recommended.

  • Provide clear and specific advice on walking and other behavior change recommendations.

  • Consistent advice on managing pain when walking is recommended

  • Group education was acceptable to participants and could be considered a pragmatic solution to provide support with limited

Acknowledgments

This study was funded by The Bupa Foundation (PPW12-033F), who had no involvement in the conduct of this study. TG acknowledges the support provided by The Carnegie Trust for the Universities of Scotland, which facilitated travel for this project. Sheffield Hallam University was the project sponsor. Initial screening and invitation of patients was conducted by the Sheffield Clinical Research Facility (Northern General Hospital, Sheffield). The authors thank Anna Myers for her assistance with

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    Conflict of interest: The authors declare that they have no competing interests.

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