"When nothing happens, nobody is afraid!" beliefs and perceptions around self-care and health-seeking behaviours: Voices of patients living with diabetic lower extremity amputation in primary care

Needs of Family Caregivers of People with Lower Limb Amputations: A Scoping Review

Lower limb amputation affects several parameters of a patient's life. Family caregivers providing care for these patients experience multiple feelings and needs; knowing caregivers' needs is essential to prepare them for this new role, as well as the health planning of this type of care. This scoping review aimed to identify and map the needs of family caregivers of people with lower limb amputations. This scoping review was conducted in accordance with the JBI methodological framework and the PRISMA-ScR reporting guidelines. A bibliographical search was carried out on the needs of family caregivers of lower limb amputees in 15 databases. Two independent reviewers extracted data using a data extraction tool developed for this scoping review. Eight studies were included in the present review (n = 6 quantitative studies; n = 2 reviews). Results indicate that family caregivers of people with lower limb amputations may experience an extensive range of needs, as follows: (i) mental health and psychological support, (ii) physical health, (iii) health and well-being, (iv) supportive care, (v) social support, and (vi) educational/informational support. The needs identified in this review can help to develop interventions and programs that provide better support during the situational transition process.

Prioritizing the Prevention of Diabetic Foot Disease: We Each Have a Role to Play

BACKGROUND

Individuals living with diabetes mellitus (DM) are at an increased risk for multiple serious health complications including diabetic foot disease (DFD). Daily, DFD contributes to increased morbidity, mortality, increased hospitalization, limb amputation, and reduced quality of life. Prevention of DFD is a foundational component of diabetes management.

PURPOSE

The purpose of this study was to explore how individuals manage the care required to protect their feet from DM related foot complications.

METHODS

This qualitative descriptive study utilized semi structured interviews to explore the perspectives of 23 participants on preventing foot care complications associated with DM. All data were analyzed using reflexive thematic analysis.

RESULTS

Participants were challenged to consistently make health choices that were congruent with recommended DM self-management for the prevention of DFD. In addition, participants intuited multiple mixed messages from healthcare providers and workplaces that appeared to diminish their individual responsibility to self-manage their DM. Findings were organized under two main themes: a) Ineffective coping: Distancing self from disease b) Vacillating responsibility: Multiple mixed messages.

CONCLUSIONS

Nurses are in a unique position to provide the education and support needed to assist individuals in carrying out the many recommended self-care strategies to reduce the risk of DFD. Contextually, nurses must encourage consistent messaging among health care providers and workplaces to prioritize the health needs of individuals living with diabetes and to support the challenging work these individuals must navigate every day. It will take a concerted effort to reinforce the message that diabetes care is a priority for everyone.

Fatalism as a Mediator of the Association Between Family Resilience and Self-Management Among Patients with Chronic Wounds in China

Purpose

The purpose of this study was to examine how fatalism acts as a mediator in the correlation between family resilience and self-management among patients with chronic wounds in China.

Participants and Methods

This study used a cross-sectional research design. A total of 269 adult patients (18-94 years old) with chronic wounds residing in Wuxi, China participated in this study. Participants completed the Chinese version of the Walsh Family Resilience Questionnaire, 16-item Chinese version of the Fatalism Scale, and Self-Management Scale of Chronic Wound Patients. We conducted correlation and mediation analyses using SPSS 27.0 and PROCESS 4.0.

Results

The results indicated family resilience was a significant positive predictor of self-management (β = 0.7101, p < 0.0001), and the pathway between family resilience and self-management was partially mediated by fatalism (Effect = 0.1432, 95% confidence interval [0.0625, 0.2341]).

Conclusion

The results indicated that incorporating spiritual interventions into future person-centered self-management programs could align with the motivation of patients with chronic wounds and their families, and reduce the negative impact of fatalism on health outcomes.

Decision-making processes for non-emergency diabetes-related lower extremity amputations: A scoping review

Living with a diabetes-related foot ulcer has significant lifestyle impacts. Whilst often considered a last resort, amputation can overcome the burden of ulcer management, for an improved quality of life. However, limited research has been conducted to understand how the decision to amputate is made for people with a chronic ulcer when amputation is not required as a medical emergency. Therefore, the aim was to identify and map key concepts in the literature which describe the decision-making for diabetes-related amputations. This review followed Arksey and O'Malley's PRISMA scoping review framework. Five electronic databases and grey literature were searched for papers which described clinical reasoning and/or decision-making processes for diabetes-related amputation. Data were extracted and mapped to corresponding domains of the World Health Organisation's International Classification of functioning, Disability and Health (ICF) framework. Ninety-four papers were included. Personal factors including emotional wellbeing, quality of life, and treatment goals are key considerations for an elective amputation. It is important to consider an individual's lifestyle and personal circumstances, as well as the pathology when deciding between amputation or conservative management. This highlights the importance of a holistic and shared decision-making process for amputation which includes assessment of a person's lifestyle and function.

Exploring the relationship between self-management behaviour, family function and health information adoption behaviour in Chinese diabetic foot patients: a mixed-methods study protocol

INTRODUCTION

Diabetic foot is a major burden and threat to individuals, families and society, making it imperative to promote good self-management behaviour. However, although nurses have provided these patients with excellent health knowledge, their self-management remains unsatisfactory. Although researches have shown that self-management requires family involvement, no research has been conducted in China on family function, specifically in the diabetic foot. Therefore, this study aimed to explore the relationship between self-management, family functioning, and health information adoption behaviour and explain the formation's reason.

METHOD AND ANALYSIS

We will conduct a mixed-methods study using an exploratory sequential study design in Zhejiang, China. In the first phase, cross-section research will be conducted using a convenient sampling strategy on 225 diabetic foot patients. SPSS V.26 was used for correlation and multiple stepwise regression analyses. Structural equation modelling will be performed by using AMOS V.24. The researchers will conduct a semistructured interview to collect qualitative data and use NVivo to analyse. Ultimately, we will 'triangulate' to integrate quantitative and qualitative data.

ETHICS AND DISSEMINATION

This study received ethical clearance from the Ethics Review Committee, the affiliated Sir Run Run Shaw Hospital of Medicine School, Zhejiang University (approval no: 2023-0145). All data collection processes will abide by health and safety measures required by the national government. Written informed consent will be obtained from all participants. The study will produce one paper that will be disseminated, to local stakeholders and participants, via local and international conferences and publications in peer-reviewed journals.

Thoughts and experiences regarding leg amputation among patients with diabetic foot ulcers: A phenomenological study

Despite lower-limb amputation being common among patients with diabetic foot ulcers, few studies have qualitatively investigated the patients' perspectives. Therefore, this study aimed to explore the thoughts and experiences of patients with diabetic foot ulcers regarding lower-limb amputation in Hong Kong. A phenomenological study using individual, semi-structured interviews was conducted with 18 participants with foot ulcers recruited in Hong Kong between July and September 2022. The interviews were audio-recorded, transcribed verbatim, and analysed using an interpretative phenomenological approach and a constant comparison strategy. The results highlighted four substantial themes: (a) coping or being alone and taciturn, (b) altered appearance impacting one's sense of maintaining social relations, (c) thoughts about self-efficacy and encountering a new normal, and (d) the possibility of a reduced gap in physical consequences between the old and new self. This study provided different perspectives of patients with a history of diabetic foot ulcers, even in cases where lower-limb amputation has not yet been performed. The results demonstrate that lower-limb amputation is considered a forbidden topic. This makes it culturally difficult for Chinese patients to discuss the matter with healthcare authorities and family members. Healthcare workers should be aware of how they communicate regarding lower-limb amputation.

Association between effect of acceptance of illness and medication adherence, metabolic control, and risk of diabetic foot in individuals with diabetes

AIMS

This study aimed to determine the association between the level of acceptance of illness and medication adherence, metabolic control, and risk of diabetic foot in patients with diabetes.

METHODS

This descriptive study was conducted with 298 patients with diabetes. The questionnaire comprised the demographic characteristics of the patients, Modified Morisky Scale and the Acceptance of Illness Scale. The study data were collected by the researchers through direct interviews using the questionnaire.

RESULTS

Acceptance of illness in patients with diabetes was statistically significantly higher in the group with a higher level of knowledge of medication adherence (p < 0.001). Moreover, the acceptance of illness had a statistically significant negative correlation with fasting plasma glucose (r = -0.198; p < 0.001) and glycated hemoglobin (r = -0.159; p = 0.006) levels in individuals with diabetes. Levels of acceptance of illness had a statistically significant association with the risk of diabetic foot (p < 0.01).

CONCLUSIONS

The study found that the level of acceptance of illness was associated with the level of knowledge about medication adherence, metabolic control, and risk of diabetic foot in individuals with diabetes. It may be recommended to conduct clinical trials to determine the effect of evaluating the level of acceptance of the illness on diabetes management and to increase this level.

The perceptions of living with diabetic foot ulcers: A systematic review and meta-synthesis of qualitative studies

BACKGROUND

Diabetic foot ulcers are associated with decreased quality of life in patients with diabetes and impose a heavy burden on patients, their families, and the health care system. For health providers, a deeper understanding of the perceptions of patients is significant. They can provide better management and direction to patients with diabetic foot ulcers, thus improving their quality of life.

OBJECTIVES

To synthesize the findings of qualitative studies to explore the perceptions of individuals living with diabetic foot ulcers.

DESIGN

A systematic review and meta-synthesis of qualitative studies.

METHODS

Published qualitative research articles were identified in PubMed, CINAHL, Embase, ISI Web of Science, Ovid, and Scopus from inception to January 2022, and bibliographical reports were reviewed. In addition, combing with the search for unpublished studies in the Google Scholar ProQuest Dissertations and Theses Database, we conducted a meta-synthesis.

RESULTS

Fourteen articles were eligible for inclusion, and the total number of included individuals was 226, with ages ranging from 28 to 84 years. The perceptions of individuals with diabetic foot ulcers synthesized four overarching themes and their subthemes: perceptions of diabetic foot ulcers (Realization, Reasons), living with diabetic foot ulcers (Change in life, Physical burdens, Emotional burdens, Economic burdens), coping with diabetic foot ulcers (Hospital attendance, Attitude toward amputation, Treatment, Management), and expectations (Expectation of health-personnel, Future expectation).

CONCLUSIONS

Individuals with diabetic foot ulcers suffer greatly in their physical, psychological, and social aspects. Comprehensive and individualized patient-centered care and appropriate families and social support for patients with diabetic foot ulcers should be provided.

Beliefs and self-reported practice of footcare among persons with type II diabetes mellitus attending selected health centres in east Trinidad

Background

It has been documented that nearly 600 million people worldwide are expected to have diabetes mellitus in 2035 and that approximately 140,000 persons aged 20-69 years living with diabetes mellitus in Trinidad and Tobago. It is also indicated that patients with type II diabetes mellitus face a higher risk of diabetic foot neuropathy and foot ulcers which increase the risk of below the knee amputation in persons living with diabetes.

Purpose

The aim of this research project was to explore the beliefs related to footcare and the self-reported footcare practice of persons with type II diabetes mellitus attending selected health centres in East Trinidad.

Method

A survey was used to explore the footcare beliefs and the self-reported footcare practice of persons with type II diabetes mellitus attending selected health centres in East Trinidad (n = 87).

Results

Participants had strong belief regarding susceptibility to foot injury, strong belief regarding the seriousness of complications of foot injury, reported good footcare practice and excellent practice of overcoming barriers to performing footcare. There is a correlation between the belief regarding susceptibility to a foot injury and age (p ≤ 0.05). Also, there is a significant correlation between belief regarding susceptibility to a foot injury, seriousness of complications and self-reported footcare practices (p ≤ 0.05).

Conclusion

This study explores and describes the beliefs and self-reported practices of footcare among individuals with type II diabetes mellitus at selected health centres in East Trinidad. It supports the Health Belief Model as an effective framework for the promotion of appropriate footcare among persons with type II diabetes mellitus.