Patient’s perspective with regards to wearing diabetic therapeutic footwear : an interpretative phenomenological analysis

Abstract

Background: Previous work has found that people living with diabetes do not wear their prescribed therapeutic footwear as instructed. The reason behind this behaviour is still uncertain although certain footwear characteristics such as shoe colour, weight, cushioning and style seem to be amongst the most common reported factors leading to reduced level of adherence. Aims : This study aims to explore the perspective of patients living with Type 2 Diabetes Mellitus in relation to the use of their prescribed diabetic stock footwear. Objectives : -To identify the individual factors and characteristics in the stock footwear that might be reducing the level of adherence in the selected population. -To identify the understanding and reasoning behind everyday footwear selection in the selected population. -This study hopes to shed light on future footwear prescription thus allowing a better level of adherence in using the prescribed therapeutic regimen. Methods : An exploratory qualitative design method using an Interpretative Phenomenological Analysis (IPA) was employed in this research. This specific branch of phenomenology was used to explore the perception of patients living with Type 2 Diabetes Mellitus in relation to the use of their prescribed diabetic stock footwear by means of interviews. Twelve participants were recruited and in-depth, semi-structured interviews were conducted, recorded, transcribed and later analysed in detail. The analysis resulted in themes which were later collated into sub-categories and two final categories. Findings : Two main categories, ‘Adherence’ and ‘Non – Adherence’ to wearing the prescribed stock footwear emerged from this study. The majority of the participants chose to adhere in certain instances (outdoors) and non-adhere in others (seasonal changes, indoors, special occasions). Adherence has been observed outdoors as the outside environment was recognised to impose risks to the high risk foot. On the other hand, non-adherence has been observed indoors, in special occasions and during seasonal changes as the footwear characteristics together with the aesthetic appearance of the prescribed shoes were not meeting up with the participant’s requirements. Conclusion : The decision of adhering or non-adhering to the prescribed stock footwear amongst the selected Maltese population was occasion dependent, as very often participants replaced the therapeutic footwear with other alternative pairs during several instances in this study. This shows that there exist a lack of knowledge regarding the underlying therapeutic benefits that the therapeutic footwear is aimed to offer. Moreover, from this study it was also concluded that participants were not ready to undergo and adapt to the behavioural change needed, that is to make use of the prescribed stock footwear at all times in order to prevent future complications.