Barriers to effective foot care: A mixed-methods assessment among persons with leprosy-related foot disabilities living in a leprosy colony in Bankura, West Bengal

Background

Leprosy-related foot ulceration remains a significant cause of disability despite the decline in global disease prevalence. Self-care practices are essential for preventing foot complications, particularly in resource-limited settings.

Aim

To assess foot care practices among leprosy-affected persons with foot disabilities and to explore the barriers to proper foot care among the study participants with unsatisfactory foot care practices.

Methods

A community-based cross-sectional mixed-method study with an explanatory sequential design was conducted in a Leprosy Colony of Bankura, West Bengal from December 2023 to August 2024. For the quantitative strand, 104 leprosy-affected adults with Grade 1 and Grade 2 foot disabilities were interviewed using a predesigned, pretested semi-structured questionnaire. In-depth interviews were conducted among seven individual with unsatisfactory foot care practices, for the qualitative strand.

Results

The median foot care practice score was 5.5 (4, 7), with 84.6% of participants having unsatisfactory practices. Women (p?0.001), widowed/never married status (p?0.004), and Grade 1 foot disability (p?0.034) were significantly associated with unsatisfactory foot care. Qualitative exploration revealed three major barrier themes: cognitive (knowledge deficits, misconceptions, low perceived disease severity), socio-economic (lack of caregivers, insufficient income, forced long-distance walking), and product-related (gender-inappropriate footwear design, poor fit, limited durability). Limitations Conducting this study in a single leprosy colony and non-probabilistic sampling method may limit generalisability and self-reported data may subject to response bias.

Conclusions

Multiple interconnected factors influence foot care practices among leprosy-affected individuals. Interventions should address gender-specific barriers, enhance risk perception among those with milder disabilities, and improve the design, fit, and quality of protective footwear to reduce disability burden.