Qualitative exploration of patient and healthcare professional perspectives on barriers and facilitators to foot self-care behaviors in diabetes

Abstract

IntroductionDiabetic foot ulcers contribute significantly to morbidity and mortality associated with diabetes, but are preventable with good foot self-care. This study sought to explore the perspectives of patients and healthcare professionals (HCPs) on barriers and/or facilitators to foot self-care behaviors in diabetes and areas of consensus and/or tension between patient and HCP perspectives.Research design and methodsThis was a sequential, qualitative study that used a hermeneutic phenomenological approach. Phase I involved nine in-depth, semi-structured patient interviews. Phase II involved seven in-depth semi-structured interviews with HCPs (podiatrists, diabetes nurses, foot health practitioners (FHPs) and general practitioners (GPs)). In phase III, findings from phases I and II were brought back to two patient interview groups (five patients in total) to try and identify any areas of consensus and tension between HCP and patient perspectives.ResultsPatient and HCP perspectives had several areas of alignment: concerns over consequences of diabetes complications; the importance of patient education and frustrations around aspects of health service delivery. There were also some notable tensions identified: mixed messaging from HCPs around whose responsibility patient foot health is; and who patients should initially consult following the development of a foot problem. Overall, patients expressed that motivation to undertake good foot self-care behaviors was generated from their lived experiences, and was enhanced when this aligned with the information they received from HCPs. HCPs appeared to attribute lack of patient motivation to lack of knowledge, which was not raised by patients.ConclusionsThis study has identified points of misalignment between the views of patients and practitioners that may help to explain why adherence to foot self-care among patients with diabetes is low. Our results suggest that better outcomes may stem from HCPs focusing on supporting autonomous motivation for self-care and enhancing the rationale through referencing patients’ own experience rather than focussing on increasing patient knowledge. Renewed focus on consistency of messaging by HCPs around the roles and responsibilities relating to foot health in diabetes, and the benefit of foot-specific training being provided to non-foot specialist HCPs may also help to improve uptake and adherence to foot self-care behaviors in diabetes.

Knowledge, attitudes and practices on diabetic foot care among nurses in Kimberley, South Africa

“… 40 Lack of time on the part of the healthcare practitioners was not reported as a barrier to educating patients about foot care in the various studies reviewed. 41 , 42 This is in keeping with our study, where most of our participants disagreed with the statement that they do not educate patients with diabetes on diabetic foot problems because it is time-consuming. However, in some studies, authors and patients reported a lack of time on the side of healthcare practitioners as a barrier to diabetic foot care.…”

“…Some practitioners prefer to pass on the responsibilities to the podiatrist as they are more focused on foot care. 42 …”

Barriers to Health Self-Management Among Older People with Hypertension and Diabetes in Institutions in China: A Phenomenological Study

“…Many older people encounter barriers to health self-management (Hill et al, 2022), which subsequently lead to severe health-related complications. The challenge of health self-management persists due to various impediments individuals face, and identifying these barriers becomes pivotal in enhancing adherence (Stiffler et al, 2014).…”

Motivational Factors in Adherence among Elderly with Diabetes and Hypertension

“…The success of these health self-management strategies is contingent upon overcoming multifarious barriers to adherence (Hill et al, 2022;Phino et al, 2021). One of the factors influencing continuous adherence is a robust sense of motivation.…”

“…Motivation is central to enhancing adherence (Phino et al, 2021). Hill et al (2022) emphasizes the importance of understanding motivational factors to empower older individuals for improved self-care and indicates that motivational factors may include intrinsic factors and extrinsic factors. Understanding these motivational factors is critical in preventing complications, formulating tailored educational materials, and prioritizing interventions that empower older individuals for enhanced self-care.…”