The Journey Toward Engagement in Self-care Management of Diabetic Foot Ulcer: A Constructivist Grounded Theory Study

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Geraldina Costa, Idevania
Patients' Engagement , Self-Management , Diabetic Foot , Diabetes Care
Background: Worldwide, diabetic foot ulcer (DFU) is the leading cause of emergency room admissions, long hospital stays, and long-term disability for individuals living with diabetes. Of all individuals with diabetes, 15–25 percent develop a DFU at some time in their lives; and 25 percent of these foot ulcers end in lower extremity amputation (LEA). While many investigators of DFU have been focused on pharmacological and technical approaches, little attention has been given to non-pharmacological approaches such as self-care management (SCM). The purpose of this qualitative study was to develop a theory that explains the process of engagement in SCM for individuals with DFUs and to identify the contextual factors influencing their engagement. Methods: A constructivist grounded theory, informed by Charmaz, was used to guide the study design. Theoretical sampling and intensive semi-structured interviews were conducted with 30 individuals with active DFU attending a wound care clinic in southeastern Ontario, Canada, in August of 2017. Data analysis was conducted alongside data collection in a cyclic research process, which began with initial coding, and proceeded to focused coding or selective coding that resulted in a model representative of the theory. Results: The study results draw attention to the complexity that exists for individuals seeking to balance life and manage diabetes and DFU. The categories and their set of concepts comprise the theory called “The Journey Toward Engagement in SCM”. The process involved five phases: 1) perception of illness, 2) noticing foot changes, 3) realizing seriousness, 4) beginning to learn about SCM, and 5) engaging in SCM. The process is influenced by multiple contextual factors, including aging and/or living with multiple chronic conditions, motivations, self-efficacy, SCM knowledge, SCM support, and access to services and resources. Conclusion: The results of my doctoral study showed the pathway participants used to learn about SCM practices and how engagement in day-to-day management of DFU occurred. It has also helped to uncover inequities in accessing formal SCM education and specialized services and resources, which in turn contribute to inform nursing practice, education, and health policy.
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