Optimizing Self-Management for People Living With Chronic Diabetic Foot Ulcers: A Longitudinal Qualitative Study.

PURPOSE: The aim of this study was to identify facilitators and barriers in dynamic self-management in order to optimize individualized strategies of persons with diabetic foot ulcers (DFUs).

DESIGN

Longitudinal qualitative research design.

PARTICIPANTS AND

SETTING

The sample comprised 18 participants diagnosed with a DFU and 10 family caregivers; respondents were recruited from Sun Yat-sen Memorial Hospital, a metropolitan tertiary center with a diabetic foot multidisciplinary care team located in Guangzhou, China.

METHODS

Semi-structured interviews were constructed guided by self- and family-management (SFM) framework. Interviews occurred around 1, 3, and 6 months after DFU diagnosis. Data were analyzed using thematic analysis. Data collection was conducted between September 2023 and June 2024.

RESULTS

Eleven subthemes were identified as either facilitators or barriers and were categorized according to the 3 stages of DFU-SFM. They were (1) SFM buildup: motivation and determination, support network at its peak, information overload and uncertainty; (2) SFM adaption: activating more resources, establishing a virtuous cycle, waning support network and accumulation of negative experiences; and (3) SFM optimization: test the boundaries, reflection and personalization and living with DFU.

CONCLUSIONS

We identified strategies to optimize DFU self-management that occurred in in stages. We hypothesize that providing earlier structured education that incorporates skills start SFM, a holistic approach that goes beyond wound care to maintain SFM, and enhancing self-monitoring and external supervision to optimize SFM.