Adherence to wearing therapeutic shoes among people with diabetes: a systematic review and reflections

Abstract

IntroductionTherapeutic shoes are prescribed to prevent diabetic foot ulcers, but adherence to wearing the shoes is often poor.AimThe aim of this study was to review the literature on factors that are associated with adherence to wearing therapeutic shoes and construct a model of adherence to aid future research and development in the field.MethodsWe conducted a systematic search in PubMed, CINAHL, and PsycINFO for quantitative studies on factors associated with adherence to wearing therapeutic shoes among people with diabetes.ResultsSix studies were included in the review. The studies focused mainly on patient-, therapy-, and condition-related adherence factors. There is some evidence (three to five studies) that sex, diabetes duration, and ulcer history are not associated with adherence. The evidence for or against the other factors was weak (only one or two studies) or conflicting.ConclusionThere is no conclusive evidence for using any factor to predict adherence to wearing therapeutic shoes, but there is some evidence against using certain factors for predicting adherence. Future studies should include a broader range of factors, including health system and social/economic factors, and they should investigate perceived costs and benefits of wearing therapeutic shoes in comparison with other shoes or no shoes. A seesaw model is presented illustrating the complex phenomenon of adherence. Further research is needed to identify factors associated with adherence to wearing therapeutic shoes, to enable the development of interventions to improve adherence and thereby reduce ulceration rates among people with diabetic foot complications.

Motivational interviewing to improve adherence behaviours for the prevention of diabetic foot ulceration

“…To this effect, future research may select pragmatic trial designs in order to explore the hugely varied and complex predictors of adherence. Studies should focus on identifying change at the level of the individual rather than within populations as is the case with traditional RCT designs …”

“…Few studies exist that explore mechanisms of adherence for improved health outcomes for complex conditions such as diabetic foot disease where the required behaviours are numerous, individual, and changeable. Adherence studies for the prevention of diabetic foot ulceration have mostly focused on wearing prescribed footwear as the target behaviour . Studies have explored whether adherence was associated with duration of diabetes, history of ulceration, amputation status, foot deformity, body mass index, activity levels, living alone, employment, education level, attractiveness of footwear, and beliefs about effectiveness of footwear .…”

“…Adherence studies for the prevention of diabetic foot ulceration have mostly focused on wearing prescribed footwear as the target behaviour . Studies have explored whether adherence was associated with duration of diabetes, history of ulceration, amputation status, foot deformity, body mass index, activity levels, living alone, employment, education level, attractiveness of footwear, and beliefs about effectiveness of footwear . There is conflicting evidence on associations between adherence and most of these factors; however, findings suggest gender, diabetes duration, and ulcer history are not predictors of adherence .…”

“…1,2,7,8 Clinicians continue to deliver traditional education in the absence of alternative approaches to enhance adherence and without the ability to identify the 10% to 15% of patients for whom traditional approaches are effective. 9 Adherence is defined as the extent to which a person's behaviour corresponds with agreed recommendations from a health care provider. 10 Behavioural change and adherence for those at risk of developing diabetic foot ulceration include wearing prescribed footwear, daily checking of feet for signs of impending ulceration, not walking barefoot to avoid accidental injury, attendance at foot-care appointments, and home foot temperature monitoring.…”

“…9,12,15 Studies have explored whether adherence was associated with duration of diabetes, history of ulceration, amputation status, foot deformity, body mass index, activity levels, living alone, employment, education level, attractiveness of footwear, and beliefs about effectiveness of footwear. 9,12 There is conflicting evidence on associations between adherence and most of these factors; however, findings suggest gender, diabetes duration, and ulcer history are not predictors of adherence. 9 It is acknowledged that there is insufficient consideration of social and environmental factors on adherence in these studies.…”