Optimizing Self-Management for People Living With Chronic Diabetic Foot Ulcers

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.