Abstract
BackgroundDiabetic foot ulceration (DFUs) is increasingly prevalent in Singapore. Appropriate management is important since DFU brings with it an associated risk for lower limb amputations, high morbidity rates and costs. Footwear prescription has been a part of clinical guidelines to manage DFUs. However, adherence to prescription footwear is typically poor amongst patients. Reasons for this have been explored in Northern American and Western European studies, but not in Singapore’s context. As cultural and climate differences limit transferability of findings from existing studies to individuals in Singapore, this study aims to explore the lived experiences of participants with diabetes using prescription footwear in Singapore.MethodsThis was a qualitative study using interpretative phenomenological analysis (IPA) to understand some people’s personal experience of using off the shelf prescription footwear. A total of 8 people with diabetes who received prescription footwear as part of their diabetic foot management were recruited. All participants provided written consent and took part in a semi-structured interview lasting up to an hour. Interviews were digitally recorded, transcribed and analysed using an IPA approach.Findings and discussionThe analysis identified the super-ordinate themes of 1) security and 2) acceptance with sub-themes of 1.1) risk and 1.2) protection and 2.1) personal and social acceptance and 2.2) social and cultural acceptance respectively that inter-related to influence how participants’ made footwear decisions. This process of evaluation was portrayed to be a fluctuant one, making it difficult to predict yet necessary to understand. A modified seesaw model of adherence is suggested to explain this decision-making process.ConclusionsThe complex manner by which participants grappled with security and acceptance is often overlooked when footwear is prescribed, highlighting a need for a more collaborative clinician-patient partnership for these issues to surface in clinical practice. Furthermore, prescription footwear should be seen more holistically. Empowering patients with choice to select from a range of therapeutic yet normalised footwear could increase the level of security and acceptance they experience with its use.
Highlights
Diabetic foot ulceration (DFUs) is increasingly prevalent in Singapore
The complex manner by which participants grappled with security and acceptance is often overlooked when footwear is prescribed, highlighting a need for a more collaborative clinician-patient partnership for these issues to surface in clinical practice
This study suggests that there is unaddressed contradiction between what some participants have been told and what they truly believe despite their history of ulceration, revealing an underlying struggle to accept the protective value of prescription footwear
Summary
Appropriate management is important since DFU brings with it an associated risk for lower limb amputations, high morbidity rates and costs. In Singapore, DFUs are significant risk factors for lower limb amputations, leading to high morbidity rates and costs [5]. While use of prescription footwear has been effective in reducing plantar pressures [15,16,17,18,19,20], this has not translated into a reduction in ulceration rates. This discrepancy has been largely attributed to patients’ poor adherence to prescription footwear [21,22,23]. While it is suggested that prescription footwear should be worn 60–80% of the day for significant reduction in ulceration risks [24, 25], studies suggest that patients only use prescription footwear 22–36% of the time [21, 26, 27]
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