Perceptions of Diet Quality, Advice, and Dietary Interventions in Individuals with Diabetes-Related Foot Ulceration; A Qualitative Research Study

Abstract

Background: Dietary intake is a recognised contributor to healing in diabetes-related foot ulceration (DFU). However, it is currently unknown how individuals with DFU perceive their diet, and what is deemed an acceptable dietary intervention. Therefore, the aims of this study were to explore perceptions of diet quality, previous dietary advice, and dietary interventions in individuals with DFU, and secondly to determine acceptable dietary interventions in individuals with DFU to assist with wound healing. Methods: A qualitative study using reflexive thematic analysis was undertaken. Individuals with active or recent history of DFU were recruited from a high-risk foot service. Semi-structured interviews were undertaken. Results: Nineteen participants were included with three themes identified: A complex relationship with food, perceptions of food, diet and dietitians, and self-management. Dietary misconceptions were common. Self-perceived diet quality varied, with most unaware of how diet could impact wound healing. Many expressed barriers relating to food agency (purchasing, preparing, and accessing food). Participants expressed a strong preference for personalised, face-to-face dietary advice and nutritional supplementation. Conclusions: There is a need for personalised dietary re-education and assistance with food agency in this cohort to overcome commonly held misconceptions of diet and improve dietary intake to facilitate wound healing.

‘Nutrition has everything to do with wound healing’—health professionals' perceptions of assessment and management of nutrition in individuals with diabetes‐related foot ulceration

“…A potential contributing factor to the lack of confidence in nutrition assessment by doctors may relate to a lack of easily applied screening tools that are suited to medical and other health practitioners. An additional major barrier to referring individuals with DFU for nutritional support for wound healing was the patient perception of dietitians as judgemental, aligning with previous research exploring the perceptions of individuals with DFU 60 . There is a need to overcome the negative stereotype of dietitians as authoritarian figures, but rather as enablers of behaviour change and leaders in positive dietary behaviours.…”

“…Furthermore, advice and management should be based on an objective nutrition assessment, which is imperative to providing personalised medical nutrition therapy 59 . Previous research concluded individuals with DFU are seeking personalised dietetic support that considers their capabilities, opportunities and motivations 60 . A potential contributing factor to the lack of confidence in nutrition assessment by doctors may relate to a lack of easily applied screening tools that are suited to medical and other health practitioners.…”

“… 59 Previous research concluded individuals with DFU are seeking personalised dietetic support that considers their capabilities, opportunities and motivations. 60 A potential contributing factor to the lack of confidence in nutrition assessment by doctors may relate to a lack of easily applied screening tools that are suited to medical and other health practitioners. An additional major barrier to referring individuals with DFU for nutritional support for wound healing was the patient perception of dietitians as judgemental, aligning with previous research exploring the perceptions of individuals with DFU.…”

“…An additional major barrier to referring individuals with DFU for nutritional support for wound healing was the patient perception of dietitians as judgemental, aligning with previous research exploring the perceptions of individuals with DFU. 60 There is a need to overcome the negative stereotype of dietitians as authoritarian figures, but rather as enablers of behaviour change and leaders in positive dietary behaviours. Overcoming these barriers is required to facilitate improved referral pathways and nutrition support for individuals with DFU.…”

“…Referral rates from doctors to dietitians for eligible conditions in Australia has been shown to be very low (0.26%), 61 and may be a result of doctors' perceptions of dietary strategies as adjunct therapies, despite being classified as first‐line therapy for some conditions such as type 2 diabetes. 62 There is an urgent need for individuals with DFU to see a dietitian, as body mass index (BMI) in the overweight/obese classes 38 , 60 and concurrent malnutrition are highly prevalent. 63 Only half of dietitians and diabetes educators in the current study completed malnutrition screening assessment in those with DFU, emphasising the need to increase awareness of the importance of malnutrition screening for all patients in this population, and the need for this to be a standard step in triage.…”