Abstract
BackgroundSelf-care in diabetes related foot disease (DFD) is challenging and contributes to poor outcomes. Motivational Interviewing (MI) can engage people in self-care and modifying it by integrating imagery may further improve its outcomes. No previous studies have trained podiatrists in using MI to address DFD self-care. This was the first study on training podiatrists to conduct imagery-based motivational interviewing (MI) when treating people with DFD, and to examine impacts on MI related skills, job satisfaction and subjective experiences in a mixed-methods pilot study.MethodsEleven recruited podiatrists (median age: 35 years, 9 female and 2 male) received two 4-h training sessions, and three received subsequent mentoring. MI and imagery skills were rated using validated tools during two clinical sessions per participant at baseline, and 2- and 12-weeks post-training. Job satisfaction was assessed at baseline and 12 weeks. Semi-structured interviews at 12 weeks were analysed using the framework approach.ResultsSignificant improvements over time (p = .006–.044) with substantial effect sizes (η2 = .50–.67) were found in three of four global MI related communication skills and two of four MI behaviours. However, effects on these indices were not sustained to 12 weeks, and imagery was rarely used. Job satisfaction was high at baseline and unchanged at follow-up (p = 0.34, η2 = .100). In qualitative interviews, MI training and skills were valued, but significant challenges in using MI when treating people with DFD were reported.ConclusionTraining podiatrists in MI may have potential but more training, observation and mentoring appear needed to obtain sustained communication changes in practice.
Highlights
Self-care in diabetes related foot disease (DFD) is challenging and contributes to poor outcomes
Since we were aware that lack of apparent engagement in effective self-care by people with DFD was a source of significant frustration for podiatrists, we examined whether the training had effects on job satisfaction
The training resulted in some moderate shortterm improvements in motivational interviewing (MI) related skills after 2 weeks, but no improvements remained at the 12-week followup, and only one podiatrist attempted to use imagery in the assessed sessions
Summary
Self-care in diabetes related foot disease (DFD) is challenging and contributes to poor outcomes. No previous studies have trained podiatrists in using MI to address DFD self-care This was the first study on training podiatrists to conduct imagery-based motivational interviewing (MI) when treating people with DFD, and to examine impacts on MI related skills, job satisfaction and subjective experiences in a mixed-methods pilot study. A major complication of diabetes is foot disease (DFD), which includes foot ulceration [2]. Multiple pathophysiological factors including peripheral artery disease and peripheral neuropathy lead to foot ulceration [3]. Around half of these ulcers become complicated by infection, often leading to hospitalisation, amputation and increased mortality [2]. Up to 75% of this foot ulceration may be prevented when evidence-based clinical care is optimised [6]
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