Adherence to limiting weight‐bearing activity in patients with diabetic foot ulcers: A qualitative study

Abstract

Patients with diabetic foot ulcers are advised to limit weight‐bearing activity for ulcers to heal. Patients often disregard this advice although the reasons are not yet fully understood. This study explored (1) patients' experiences of receiving the advice and (2) factors influencing adherence to the advice. Semi‐structured interviews were conducted with 14 patients with diabetic foot ulcers. Interviews were transcribed and analysed using inductive thematic analysis. Advice regarding limiting weight‐bearing activity was described by patients as directive, generic and conflicting with other priorities. Rapport, empathy and rationale supported receptivity to the advice. Barriers and facilitators to limiting weight‐bearing activity included demands of daily living, enjoyment of exercise, sick/disabled identity and burden, depression, neuropathy/pain, health benefits, fear of negative consequences, positive feedback, practical support, weather and active/passive role in recovery. It is important that healthcare professionals pay attention to how limiting weight‐bearing activity advice is communicated. We propose a more person‐centred approach in which advice is tailored to individuals' specific needs with discussion around patient priorities and constraints.

Development of a Motivation Communication Training to Aid Diabetes-Specialist Podiatrists With Adherence Discussions

“…The aim of Step 1 was to establish an understanding of what needs to be changed and the specific context for the intervention. As detailed in the introduction, patient-provider communication is an important factor influencing adherence in patients living with DFUs (e.g., Coffey et al, 2019 ; Gale et al, 2008 ; Hancox et al, 2023 ; Searle et al, 2008 ). Observation was undertaken to gain a detailed understanding of behavior change conversations in routine DFU consultations and the extent to which such discussions are aligned with SDT and MI approaches.…”

“…The selection of theory and evidence-based SDT strategies and MI techniques was informed by Stage 1 needs assessment findings, consultation with a patient and public involvement (PPI) group, health care professional advisory group, and guided by a proficient MI practitioner. Examples within the training were focused on discussions regarding patients’ limiting weight-bearing activity as this has been highlighted by podiatrists (health care professional advisory group) and patients ( Hancox et al, 2023 ) as an area for improvement. However, the motivational strategies can be applied to other adherence-related conversations.…”

“…Another limitation of the present study is the lack of exploration of patients’ views on receiving care from podiatrists who have undergone the training, a noteworthy avenue for future research. The present study focused on health care communication, and other barriers to patient treatment adherence (e.g., lack of pain, depression; Hancox et al, 2023 ) could be addressed in future research.…”

“…Furthermore, Searle and colleagues (2008) interviewed podiatrists who expressed frustration and lack of support in their efforts to empower and establish collaborative partnerships with their patients. More recent research conducted by Hancox et al (2023) interviewed patients regarding delivery of treatment advice specifically in relation to limiting weight-bearing activity. Patients reported that often treatment advice is delivered in a directive and generic manner and expressed a preference for a more person-centered approach with advice tailored to their specific needs via a process of collaborative problem-solving.…”

Motivation communication training programme for healthcare professionals to support adherence in patients with diabetic foot ulcers: Proof of concept study

“…This practice is based on recommendations from the International Working Group of the Diabetic Foot [ 11 ], derived from research evidence that patient activity levels are negatively associated with DFU wound healing [ 22 , 23 ]. However, patients have reported limiting weight-bearing activity challenging [ 14 , 15 ]. Thus, exploration as to how to support adherence to support weight-bearing activity reduction in patients with DFUs is needed.…”