Factors influencing the use of therapeutic footwear in persons with diabetes mellitus and loss of protective sensation: A focus group study

Athra Malki; Gijsbertus J Verkerke; Rienk Dekker; Juha M Hijmans

doi:10.1371/journal.pone.0280264

Factors influencing the use of therapeutic footwear in persons with diabetes mellitus and loss of protective sensation: A focus group study

PLoS One. 2023 Jan 12;18(1):e0280264. doi: 10.1371/journal.pone.0280264. eCollection 2023.

Authors

Athra Malki¹, Gijsbertus J Verkerke^{1

2}, Rienk Dekker¹, Juha M Hijmans¹

Affiliations

¹ Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Groningen, The Netherlands.
² Department of Biomechanical Engineering, University of Twente, Enschede, Overijssel, The Netherlands.

Abstract

Background: Persons with diabetes mellitus (DM) and loss of protective sensation (LOPS) due to peripheral neuropathy do not use their therapeutic footwear (TF) consistently. TF is essential to prevent foot ulceration. In order to improve compliance in using TF, influencing factors need to be identified and analyzed. Persons with a history of foot ulceration may find different factors important compared with persons without ulceration or persons who have never used TF. Therefore, the objective of this study was to determine factors perceived as important for the use of TF by different groups of persons with DM and LOPS.

Method: A qualitative study was performed using focus group discussions. Subjects (n = 24) were divided into 3 focus groups based on disease severity: ulcer history (HoU) versus no ulcer history (no-HoU) and experience with TF (TF) versus no experience (no-TF). For each group of 8 subjects (TF&HoU; TF&no-HoU; no-TF&no-HoU), an online focus group discussion was organized to identify the most important influencing factors. Transcribed data were coded with Atlas.ti. The analysis was performed following the framework approach.

Results: The factors comfort and fit and stability/balance were ranked in the top 3 of all groups. Usability was ranked in the top 3 of group-TF&noHoU and group-noTF&noHoU. Two other factors, reducing pain and preventing ulceration were ranked in the top 3 of group-TF&noHoU and group-TF&HoU, respectively.

Conclusion: Experience with TF and a HoU influence which factors are perceived as important for TF use. Knowledge of these factors during the development and prescription process of TF may lead to increased compliance. Although the main medical reason for TF prescription is ulcer prevention, only 1 group gave this factor a high ranking. Therefore, next to focusing on influencing factors, person-centered education on the importance of using TF to prevent ulcers is also required.

Copyright: © 2023 Malki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Diabetes Mellitus*
Diabetic Foot* / prevention & control
Focus Groups
Foot Ulcer*
Humans
Peripheral Nervous System Diseases*
Sensation
Shoes

Grants and funding

JMH received the funding for this work by EIT Health: https://eithealth.eu/. The Grant number was 211018. This work was part of the research project titled: ‘IndiRock'nSole’. The funder had no role in the study design, data-collection and analysis, decision to publish, or preparation of the manuscript.