Abstract
Diabetic foot ulceration (DFU) is a common and debilitating complication of diabetes that is preventable through active engagement in appropriate foot-related behaviours, yet many individuals with diabetes do not adhere to foot care recommendations. The aim of this paper was to synthesise the findings of qualitative papers exploring diabetic people's perceptions and experiences of DFU in order to identify how they could be better supported to prevent ulceration or manage its impact. Five databases (MEDLINE, PsycINFO, CINAHL, EMBASE, Web of Science) were searched in May 2016 to identify eligible articles. Findings were synthesised using a meta-ethnographic approach. Forty-two articles were eligible for inclusion. Synthesis resulted in the development of five overarching themes: personal understandings of diabetic foot ulceration; preventing diabetic foot ulceration: knowledge, attitudes, and behaviours; views on health care experiences; development of diabetic foot ulceration and actions taken; and wide-ranging impacts of diabetic foot ulceration. The findings highlight various barriers and facilitators of foot care experienced by people with diabetes and demonstrate the significant consequences of ulcers for their physical, social, and psychological well-being. The insights provided could inform the development of interventions to promote foot care effectively and provide appropriate support to those living with ulceration.
Highlights
Diabetic foot ulceration (DFU) is among the most common and debilitating complications of diabetes, with a lifetime incidence of up to 25% in people with this condition.[1]
Diabetic foot ulceration is a common and debilitating complication of diabetes; ulcers are often preventable through appropriate foot-related behaviours, many individuals with diabetes do not adhere to foot care recommendations
Our findings indicate that participants in the included studies did not have a deficit of knowledge but, rather, had alternative interpretations of DFU at odds with medical explanations of this condition, which had a significant influence on their behavioural choices
Summary
Diabetic foot ulceration (DFU) is among the most common and debilitating complications of diabetes, with a lifetime incidence of up to 25% in people with this condition.[1]. At least one-third of direct costs generated by the treatment of diabetes and its complications in the United States is linked to DFU.[5] The personal, societal, and economic costs of DFU, coupled with the rapidly increasing prevalence of diabetes worldwide,[6] highlights the importance of developing effective prevention strategies and supports. It is estimated that at least 75% of all cases could be avoided through high-quality preventive care.[7] The patient's active engagement in foot care is a cornerstone of successful prevention.[8,9] Key behaviours that reduce the risk of developing DFU include daily inspection of feet and immediate reporting of irregularities to a health professional, avoidance of behaviours that place the foot at risk (eg, walking barefoot), consistent use of appropriate
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