“When nothing happens, nobody is afraid!” beliefs and perceptions around self‐care and health‐seeking behaviours: Voices of patients living with diabetic lower extremity amputation in primary care

Abstract

Self-management and self-care are the cornerstone of diabetes care and an essential part of successfully preventing or delaying diabetes complications. Yet, despite being armed with the required information and guidance for self-management, self-care and adherence to foot self-care recommendations and compliance to medication among patients with diabetic foot ulcer and diabetic lower extremity amputations remain low and suboptimal. This study reveals in-depth account of nine such patients' beliefs and perceptions around their illness, their self-care, and their health-seeking behaviours. Patients living with diabetic lower extremity amputation displayed profound lack of knowledge of self-care of diabetes and foot and passive health-related behaviours. The overarching sense that "when nothing happens, nobody is afraid," points to a lack of motivation in taking charge of one's own health, whether this is with reference to treatment or care adherence, following recommended self-care advice, or seeking timely treatment. The Health Beliefs Model provides the theoretical framework for probing into the factors for the participants' suboptimal self-care and passive health-seeking behaviours. Two themes emerged from data analysis: profound knowledge deficit and passive healthrelated behaviours. The beliefs and perceptions around self-care and healthseeking behaviours for patients with lower extremity amputation are interpreted as the "ignorant self" with passive health-seeking behaviours. Patients with diabetes and diabetic foot diseases may benefit from personalized education, motivational interviewing, and family support.

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

“…Similarly, in a recent study conducted in Tobago, most participants believed that walking barefooted exposes the foot to being pierced by any object, leading to a deep cut, foot ulcer, foot infection, and, consequently, amputation of the foot. This finding conform to Adeyemi et al [35].…”

Exploring barriers and enablers of self‐management behaviours in patients with diabetic foot ulcers: A qualitative study from the perceptions of patients, caregivers, and healthcare professionals in primary care

“…The vast majority of DFUs and DLEAs are preventable 10 and failures or delays in timely treatment or self‐care especially could explain the increasing trends. Foot self‐care is pivotal to preventing DFU recurrence and reducing the rates of DLEAs, 3,11‐13 but it is often ignored 14,15 . While important, education about foot care alone is often insufficient in improving self‐care and preventing DFU recurrence 16,17 .…”

Factors influencing foot care behaviour among patients with diabetes: An integrative literature review

“…Such findings were corroborated by Zhu et al (2021), who found that patients' perceived insusceptibility had caused them to prioritize other commitments over foot care. Furthermore, patients' passivity in adopting DFCBs might arise from their perception that diabetes was not a condition with severe complications (Zhu et al, 2021). Kim and Han (2020) observed that diabetic patients' perceived severity…”

“…The reasons were twofold: they had not had any apparent symptoms of foot injuries (Abu-Qamar & Wilson, 2011;Sari et al, 2021), and they had erroneously believed that glycemic control should take precedence over foot care (Sari et al, 2021). Such findings were corroborated by Zhu et al (2021), who found that patients' perceived insusceptibility had caused them to prioritize other commitments over foot care. Furthermore, patients' passivity in adopting DFCBs might arise from their perception that diabetes was not a condition with severe complications (Zhu et al, 2021).…”

“…services; poor insurance coverage; lack of emphasis on foot care education by health professionals; and lack of family support (Abu-Qamar & Wilson, 2011;Chin et al, 2019;Fayfman et al, 2020;Sari et al, 2021;Zhu et al, 2021). Two studies from Taiwan revealed that patients who faced fewer barriers exhibited better DFCBs (Chin et al, , 2019.…”