Exploring barriers and facilitators to good foot self-care practices
Research type
Research Study
Full title
Exploring patient and healthcare-professional perspectives on barriers and facilitators towards foot self-care practices in diabetes.
IRAS ID
266394
Contact name
Andrew RH Hill
Contact email
Sponsor organisation
University of Bath
Duration of Study in the UK
1 years, 3 months, 0 days
Research summary
Summary of Research
Exploring patient and healthcare-professional perspectives on barriers and facilitators towards foot self-care practices in diabetes.Foot ulceration is a common but serious complication of diabetes mellitus resulting in a foot or lower limb amputation every 30 seconds across the globe. There has been much focus on means to try and prevent foot ulceration in diabetes but this continues to be an increasing problem. More recent approaches are looking towards prevention via good patient education and optimal self-care behaviours for individuals with diabetes. Despite this, however, instilling good foot self-care behaviours remains a challenge.
Accordingly, this study primarily seeks to explore patient and healthcare-professional perspectives on perceived barriers and facilitators to foot self-care practices in diabetes. In addition, this study will explore whether similarities and/or differences between patient and healthcare-professional perspectives in this context contribute to these barriers and/or facilitators.The focus of this study is adults with diabetes at ‘low-risk’ of developing foot complications as ‘low-risk’ populations often become ‘high-risk’ in time. This will be a sequential exploratory qualitative study. An initial phase (I) of semi-structured interviews relating to foot self-care behaviours and perceived barriers and enablers to these behaviours will be undertaken with individuals with diabetes at low-risk of developing foot complications. The data from these interviews will then be thematically analysed using interpretive phenomenological analysis. Identified themes from the interviews will guide phase II and the presentation of these themes to key healthcare professionals involved in diabetic foot care for their consideration and discussion via in-depth, semi-structured interviews. These interviews will then be thematically analysed using interpretive phenomenological analysis to allow any consensus and/or disagreement between the professional stakeholder(s) and the patient interview themes to be identified. The third (III) phase will see phase II themes presented back to the patient participants (some of whom who may have taken part in phase I) for discussion within a focus group. The data from the discussion within this focus group will be analysed using a suitable method of qualitative analysis which will be determined by the nature of the data that comes from the focus group discussion.
Consequently, a synthesised composition of patient and healthcare-professional perspectives within this area of diabetes care may identify whether similarities and/or differences in perspective between the patient and the healthcare-professional contributes to barriers and/or facilitators to patient foot self-care practices. It is hoped that this composition may provide unique insight that may guide and shape the development of an intervention aimed at improving foot self-care practices within the low-risk diabetes population to help prevent these patients ultimately developing a diabetic foot ulcer.
Summary of Results
Patient and healthcare professional perspectives on barriers and facilitators to foot self-care behaviours in diabetes had several areas of alignment. These were: 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 healthcare professionals 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 behaviours was generated from their lived experiences, and was enhanced when this aligned with the information they received from healthcare professionals. Healthcare professionals, meanwhile, appeared to attribute lack of patient motivation to lack of knowledge, which was not raised by patients.This 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. The findings of this study suggest that better outcomes may stem from healthcare professionals 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 healthcare professionals around the roles and responsibilities relating to foot health in diabetes, and the benefit of foot-specific training being provided to non-foot-specialist healthcare professionals may also help to improve uptake and adherence to foot self-care behaviours in diabetes.
REC name
London - City & East Research Ethics Committee
REC reference
19/LO/1497
Date of REC Opinion
23 Oct 2019
REC opinion
Favourable Opinion