Patients' perspectives on foot complications in type 2 diabetes: a qualitative study

Abstract

Background: Foot ulceration is a major health problem for people with diabetes. To minimise the risk of ulceration, patients are advised to perform preventive foot self-care.

Aim: To explore beliefs about diabetic foot complications and everyday foot self-care practices among people with type 2 diabetes.

Design of study: Qualitative study using one-to-one interviews.

Setting: A suburban primary care health centre.

Method: Semi-structured interviews with a purposive sample of adults with type 2 diabetes but with no experience of foot ulceration.

Results: Most participants were unsure of what a foot ulcer is and unaware of the difficulties associated with ulcer healing. Prevention of accidental damage to the skin was not considered a priority, as few participants knew that this is a common cause of foot ulceration. Although it was recognised that lower-limb amputation is more common in people with diabetes, this was perceived to be predominantly caused by poor blood supply to the feet and unrelated to foot ulceration. Therefore, preventive foot care focused on stimulating blood circulation, for example by walking barefoot. Consequently, some of the behaviours participants considered beneficial for foot health could potentially increase the risk of ulceration. In some cases the uptake of advice regarding preventive foot care was hampered because participants found it difficult to communicate with health professionals.

Conclusion: Patients with type 2 diabetes may have beliefs about foot complications that differ from medical evidence. Such illness beliefs may play a role in foot-related behaviours that have previously been unrecognised. Health professionals need to explore and address the beliefs underlying patients' foot self-care practices.

Appendix 1

Predisposing and precipitating risk factors for foot ulceration.

Appendix 2

Medical model^a of lower-limb complications in diabetes. ^aThe model is a simplified version of the most common pathway to amputation in patients with diabetes.^,–

Appendix 3

Participants' model^a of lower limb complications in diabetes. ^aThe model is based on participants' interpretation of the main causes of amputation in diabetes. The thick arrows at the top indicate the pathway to amputation thought to be the most common. The pathway in the lower half was thought to be rare. The broken lines indicate that very few participants mentioned the connection.