Journal of Qualitative Research in Health Sciences

Document Type : Original Article

Authors

1 Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Community-Oriented Nursing Midwifery Research Center, Nursing and Midwifery School, Shahrekord University of Medical Sciences, Shahrekord, Iran

10.34172/jqr.2024.20

Abstract

Background: Diabetic foot ulcer (DFU) is one of the serious and debilitating challenges faced by patients with diabetes, which imposes a financial burden on both patients and healthcare systems. Although this problem can be prevented and treated by proper foot care techniques, many patients do not follow the recommendations. Accordingly, this study aimed to rely on deep insight and knowledge to explain diabetic patients’ perception of DFU and identify appropriate care and support practices to prevent and manage it.
Methods: This descriptive study was conducted using qualitative content analysis. The participants were 15 patients with diabetes, who visited the healthcare centers in Shahrekord, Iran selected using purposive sampling. Data were collected through face-to-face and semi-structured interviews with the participants until data saturation. Data were analyzed simultaneously with data collection using the method proposed by Graneheim and Lundman.
Results: Data analysis led to the identification of four main categories including being destined to a doomed fate, self-treatment, indifference to obsessive care, and care-inhibiting beliefs.
Conclusion: To gain a deeper understanding of standard foot care, the causes of foot ulcers, preventive care services, and existing treatments, different strategies can be adopted such as peer education or using the experiences of other patients with ulcers.

Keywords

  1. Jarvis J, Skinner TC, Carey ME, Davies MJ. How can structured self-management patient education improve outcomes in people with type 2 diabetes? Diabetes Obes Metab. 2010;12(1):12-9. doi: 10.1111/j.1463-1326.2009.01098.x.
  2. Mardanian Dehkordi L, Abdoli S. Diabetes self-management education; experience of people with diabetes. J Caring Sci. 2017;6(2):111-8. doi: 10.15171/jcs.2017.011.
  3. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103(2):137-49. doi: 10.1016/j.diabres.2013.11.002.
  4. Khamseh ME, Ghajarieh Sepanlou S, Hashemi-Madani N, Joukar F, Mehrparvar AH, Faramarzi E, et al. Nationwide prevalence of diabetes and prediabetes and associated risk factors among Iranian adults: analysis of data from PERSIAN cohort study. Diabetes Ther. 2021;12(11):2921-38. doi: 10.1007/s13300-021-01152-5.
  5. Sharifirad GH, Azadbakht L, Faizi A, Mohebbi S, Karegar M, Rezai AS. Clarifying the role of self-efficacy in patients with diabetes. Journal of Special Health System Health. 2011;7(6):648-59. [Persian].
  6. Grover A, Sharma K, Gautam S, Gautam S, Gulati M, Singh SK. Diabetes and its complications: therapies available, anticipated and aspired. Curr Diabetes Rev. 2021;17(4):397- 420. doi: 10.2174/1573399816666201103144231.
  7. Kerr M. Diabetic Foot Care in England: An Economic Study. London: Diabetes UK; 2017 .
  8. Woods TJ, Tesfay F, Speck P, Kaambwa B. Economic evaluations considering costs and outcomes of diabetic foot ulcer infections: a systematic review. PLoS One. 2020;15(4):e0232395. doi: 10.1371/journal.pone.0232395.
  9. Navarro-Flores E, Cauli O. Quality of life in individuals with diabetic foot syndrome. Endocr Metab Immune Disord Drug Targets. 2020;20(9):1365-72. doi: 10.2174/18715303206662 00128154036.
  10. Lo ZJ, Surendra NK, Saxena A, Car J. Clinical and economic burden of diabetic foot ulcers: a 5-year longitudinal multi-ethnic cohort study from the tropics. Int Wound J. 2021;18(3):375-86. doi: 10.1111/iwj.13540.
  11. Edmonds M, Manu C, Vas P. The current burden of diabetic foot disease. J Clin Orthop Trauma. 2021;17:88-93. doi: 10.1016/j.jcot.2021.01.017.
  12. Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366(9498):1719-24. doi: 10.1016/s0140- 6736(05)67698-2.
  13. Ragnarson Tennvall G, Apelqvist J. Health-economic consequences of diabetic foot lesions. Clin Infect Dis. 2004;39 Suppl 2:S132-9. doi: 10.1086/383275.
  14. Tan JH, Hong CC, Shen L, Tay EY, Lee JK, Nather A. Costs of patients admitted for diabetic foot problems. Ann Acad Med Singap. 2015;44(12):567-70.
  15. Altoijry A, AlGhofili H, Alanazi SN, AlHindawi DA, AlAkeel NS, Julaidan BS, et al. Diabetic foot and peripheral arterial disease. Single centre experience. Saudi Med J. 2021;42(1):49- 55. doi: 10.15537/smj.2021.1.25640.
  16. Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis (†). Ann Med. 2017;49(2):106-16. doi: 10.1080/07853890.2016.1231932.
  17. Boulton AJ. The diabetic foot. Medicine. 2019;47(2):100-5. doi: 10.1016/j.mpmed.2018.11.001.
  18. Fejfarová V, Jirkovská A, Dragomirecká E, Game F, Bém R, Dubský M, et al. Does the diabetic foot have a significant impact on selected psychological or social characteristics of patients with diabetes mellitus? J Diabetes Res. 2014;2014:371938. doi: 10.1155/2014/371938.
  19. Nasrabadi Nasrabadi A, Mardanian Dehkordi L, Khoshkesht S, Najafi F. Unsuccessful diabetes management: a qualitative study. Clin Diabetol. 2021;10(2):195-9. doi: 10.5603/ DK.a2021.0012.
  20. van Puffelen AL, Heijmans MJ, Rijken M, Rutten GE, Nijpels G, Schellevis FG. Illness perceptions and self-care behaviours in the first years of living with type 2 diabetes; does the presence of complications matter? Psychol Health. 2015;30(11):1274- 87. doi: 10.1080/08870446.2015.1045511.
  21. Hjelm K, Apelqvist J. Influence of beliefs about health and illness on self-care and care-seeking in foreign-born people with diabetic foot ulcers: dissimilarities related to origin. J Wound Care. 2016;25(11):602-16. doi: 10.12968/ jowc.2016.25.11.602.
  22. Özkan İ, Taylan S, Polat Dünya C. Investigation of the relationship between the use of complementary alternative medicine and illness perception and illness cognition in patients with diabetic foot ulcer. J Tissue Viability. 2022;31(4):637-42. doi: 10.1016/j.jtv.2022.08.005.
  23. Indrayana S, Guo SE, Lin CL, Fang SY. Illness perception as a predictor of foot care behavior among people with type 2 diabetes mellitus in Indonesia. J Transcult Nurs. 2019;30(1):17- 25. doi: 10.1177/1043659618772347 .
  24. Xiong C, He Y, Zhang Y, Mai L, Chen J, Zhang Y, et al. Relationship between illness perception and self-management behaviors among Chinese diabetic foot patients. Jpn J Nurs Sci. 2023;20(4):e12550. doi: 10.1111/jjns.12550.
  25. Aalaa M, Sanjari M, Shahbazi S, Shayeganmehr Z, Abooeirad M, Amini MR, et al. Diabetic foot workshop: improving technical and educational skills for nurses. Med J Islam Repub Iran. 2017;31:8. doi: 10.18869/mjiri.31.8.
  26. Coffey L, Mahon C, Gallagher P. Perceptions and experiences of diabetic foot ulceration and foot care in people with diabetes: a qualitative meta-synthesis. Int Wound J. 2019;16(1):183- 210. doi: 10.1111/iwj.13010.
  27. Sayampanathan AA, Cuttilan AN, Pearce CJ. Barriers and enablers to proper diabetic foot care amongst community dwellers in an Asian population: a qualitative study. Ann Transl Med. 2017;5(12):254. doi: 10.21037/atm.2017.04.31.
  28. McInnes A, Jeffcoate W, Vileikyte L, Game F, Lucas K, Higson N, et al. Foot care education in patients with diabetes at low risk of complications: a consensus statement. Diabet Med. 2011;28(2):162-7. doi: 10.1111/j.1464-5491.2010.03206.x.
  29. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105- 12. doi: 10.1016/j.nedt.2003.10.001.
  30. Drisko J, Maschi T Content Analysis (Pocket Guide to Social Work Research Methods). New York: Oxford University Press; 2015.
  31. Guba EG. Criteria for assessing the trustworthiness of naturalistic inquiries. ECTJ. 1981;29(2):75-91. doi: 10.1007/ bf02766777.
  32. Esteghamati A, Etemad K, Koohpayehzadeh J, Abbasi M, Meysamie A, Noshad S, et al. Trends in the prevalence of diabetes and impaired fasting glucose in association with obesity in Iran: 2005-2011. Diabetes Res Clin Pract. 2014;103(2):319-27. doi: 10.1016/j.diabres.2013.12.034.
  33. Algshanen MA, Almuhanna MF, Almuhanna AM, Alghobaish FF, Bari OS, Alajji NA, et al. Diabetic foot awareness among diabetic patients in Saudi Arabia. Egypt J Hosp Med. 2017;68(2):1289-90. doi: 10.12816/0039063.
  34. Pourkazemi A, Ghanbari A, Khojamli M, Balo H, Hemmati H, Jafaryparvar Z, et al. Diabetic foot care: knowledge and practice. BMC Endocr Disord. 2020;20(1):40. doi: 10.1186/ s12902-020-0512-y.
  35. Ul Haq N, Durrani P, Nasim A, Riaz S. Assessment of knowledge and practice of diabetes mellitus patients regarding foot care in tertiary care hospitals in Quetta, Pakistan. Spec J Med Res Health Sci. 2017;2(4):35-43.
  36. Taksande BA, Thote M, Jajoo UN. Knowledge, attitude, and practice of foot care in patients with diabetes at central rural India. J Family Med Prim Care. 2017;6(2):284-7. doi: 10.4103/2249-4863.219994.
  37. Manickum P, Mashamba-Thompson T, Naidoo R, Ramklass S, Madiba T. Knowledge and practice of diabetic foot care - a scoping review. Diabetes Metab Syndr. 2021;15(3):783-93. doi: 10.1016/j.dsx.2021.03.030.
  38. Bonner T, Harvey IS, Sherman L. A qualitative inquiry of lower extremity disease knowledge among African Americans living with type 2 diabetes. Health Promot Pract. 2017;18(6):806- 13. doi: 10.1177/1524839916688867.
  39. Saurabh S, Sarkar S, Selvaraj K, Kar SS, Kumar SG, Roy G. Effectiveness of foot care education among people with type 2 diabetes in rural Puducherry, India. Indian J Endocrinol Metab. 2014;18(1):106-10. doi: 10.4103/2230-8210.126587.
  40. Shah VN, Kamdar PK, Shah N. Assessing the knowledge, attitudes and practice of type 2 diabetes among patients of Saurashtra region, Gujarat. Int J Diabetes Dev Ctries. 2009;29(3):118-22. doi: 10.4103/0973-3930.54288.
  41. George H, Rakesh P, Krishna M, Alex R, Abraham VJ, George K, et al. Foot care knowledge and practices and the prevalence of peripheral neuropathy among people with diabetes attending a secondary care rural hospital in southern India. J Family Med Prim Care. 2013;2(1):27-32. doi: 10.4103/2249- 4863.109938.