Behaviour change approaches for individuals with diabetes to improve foot self‐management: a scoping review

Abstract

Background Diabetes related foot complications are increasing in complexity, frequency and cost. The application of self-management strategies can reduce the risk of individuals developing foot complications. The type, range and nature of the literature focusing on interventions that support patients with diabetic foot self-management is unknown. This scoping review aimed to i) identify self-management actions and risky behaviour avoidance strategies within interventions, ii) map the theoretical functions through which these behaviour change interventions have an effect, iii) display gaps in the research. Methodology Arksey and Malley’s (2003) 5 stage framework was followed to conduct the scoping study. This methodological framework was selected because it was developed specifically for scoping reviews and therefore offered clear methodological distinction from systematic review methodology. . Databases were searched from inception of the project until June 2020 supplemented by hand searching of reference lists. In total 988 papers were identified. These were independently screened by three reviewers, identifying 19 eligible papers. Data extraction and charting of data was independently conducted by three reviewers to identify study characteristics, self-management actions and risky behaviours. Data was charted against the COM-B (capability, opportunity, motivation, behaviour) model of behaviour to determine intervention function. Results In total 25 different foot self-management actions and risk behaviours were classified into three themes; routine self-management, trauma avoidance and warning signs and actions. Inspect feet daily received the most attention. The majority of interventions focused on knowledge and skills, but overlooked taking action and decision making. Intervention mapping identified four primary intervention functions (education, persuasion, training and enablement) used to address deficits in capability, opportunity and motivation that positively improved foot self-management behaviour. No studies targeted first ulcer prevention, and most either did not measure or improve foot health outcomes. Conclusion This review charted the evidence for interventions promoting diabetic foot self-management through a theoretical behaviour change perspective. A core set of behaviour change activities and intervention functions associated with positive changes in behaviour were identified. This information will provide researchers with a useful basis for developing self-management interventions.

Client Independence Development Model in Wound Treatment Self-Based Treatment and Telenursing Nursing as Visible: A Study Literature (Paradigm of Nursing 21st century)

“…The intervention given must be clear in type, scope and reference literature that supports self-management of patients with independence. This review covers the objectives of i) identifying actions in selfmanagement and avoiding risky behavior as a strategy in giving intervention, ii) mapping theoretical functions through this behavior change with good effect interventions, iii) presenting gaps in research (Paton et al, 2021). From another point of view in this article, the safety aspect is a very important part of all health management planning.…”

Beliefs and self-reported practice of footcare among persons with type II diabetes mellitus attending selected health centres in east Trinidad

“…This phenomenon was evident in a study from Papua New Guinea which found that perceptions and beliefs about the cause of foot ulcers, particularly the 'belief in sorcery' played a role in behaviours related to footcare and was the most common cause of late presentation of diabetic septic foot [13]. Literature suggests that individuals cannot arbitrarily choose to believe anything or change a belief on a personal whim, and knowing that an individual has a true belief about some situation may not allow for the prediction of actions if the attributed beliefs are underspecified [9,14].…”

“…Footcare knowledge help with preventing foot ulcers in diabetic patients [1,11,13,26]. However, evidence shows that people with diabetes mellitus often fail to employ the behavioural strategies suggested in educational interventions and discrepancies in footcare practice persist despite understanding appropriate footcare behaviours [6,17,26,27].…”

Encouraging foot care in people with and without diabetes through narrative communication

“…The aforementioned guidelines concern foot care for individuals who have diabetes, but routine checking of feet can also minimize or delay foot problems even among those without diabetes (NICE, 2019). A recent review of interventions promoting diabetes foot self-management (Paton et al, 2021) identified no studies specifically targeting people without diabetes. Educating people with and without diabetes about the risk of foot problems and how they can minimise their risk through recommended foot care behaviours is important (Lipsky et al, 2012; Powers et al, 2020; Schaper et al, 2020).…”