Abstract
Objectives: The purpose of this study is to identify the relationship between wound severity, discomfort, and psychological problems in patients with a diabetic foot ulcer in Indonesia. Methods: A cross-sectional study is conducted in three general hospitals and one clinic in Indonesia. The Bates-Jensen wound assessment tool (BWAT), the discomfort evaluation of wound instrument (DEWI), and the depression, anxiety, and stress scale (DASS) are used to measure the variables of interest. Path analysis is performed to evaluate the association between wound severity, discomfort, and psychological problems. Results: Of 140 patients with diabetic foot ulcers who joined this study, the majority experienced immobilization (74.3 %), pain (69.3 %), and sleep disturbance (63.6 %). The means were as follows: discomfort (2.35 ± 0.33), depression (1.34 ± 0.41), stress (1.49 ± 0.48), anxiety (1.43 ± 0.40), and wound severity (31.35 ± 9.96). Discomfort partially mediated the relationship between wound severity and psychological problems, which indirect effect was 0.11. Conclusion: High prevalence of discomfort, both physical and psychological, was found in patients with a diabetic foot ulcer. Discomfort mediates the relationship between wound severity and psychological problems. Integrating comfort into wound care management may help to reduce the psychological burden.
Highlights
Diabetes mellitus (DM) is a significant public health issue and a socioeconomic burden in Indonesia
Indonesia is ranked as having the seventh-largest number of DM patients in the world, and the number of people with diabetes was 10.7 million (6.2 %) of the total population in 2019 [1]
The analysis showed a significant correlation between wound severity, discomfort, and psychological problems (p < 0.005)
Summary
Diabetes mellitus (DM) is a significant public health issue and a socioeconomic burden in Indonesia. Indonesia is ranked as having the seventh-largest number of DM patients in the world, and the number of people with diabetes was 10.7 million (6.2 %) of the total population in 2019 [1]. DM caused 4.2 million deaths and at least USD 760 billion in health expenditure in 2019—10 % of total spending on adults [1]. Diabetic foot complications constitute a major health burden, amounting to the single most substantial reason for hospitalization among diabetic patients. Up to 2–3 % of DM patients are thought to have an active foot ulcer with a lifetime risk of developing complications [2, 3]. The International Diabetes Federation states that 9.1 to 26.1 million people with diabetes will suffer from a diabetic foot ulcer (DFU) each year [4, 5]
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