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Socioeconomic Factors Influencing Self-management of Diabetic Foot Ulcer


The title of the current ANS featured article is “I Cannot Afford Off-loading Boots: Perceptions of Socioeconomic Factors Influencing Engagement in Self-management of Diabetic Foot Ulcer” authored by Idevania G. Costa, PhD, RN, NSWOC; Deborah Tregunno, PhD, RN and Pilar Camargo-Plazas, PhD, RN. The article is available to download at no cost while it is featured! Here is a message from Dr. Costa about this work:

During my experience providing care for individuals with chronic conditions for almost two decades and delivering wound care for marginalized people (e.g., low-income and minority groups) in society, I witnessed patients facing several struggles to achieve the desired outcomes, being oppressed and prevented from being actively involved in decision-making about their own care. They were victims of a biomedical model that often places individuals as passive subject in their own care and prevents them from taken on a more active role in order to achieve better outcomes. Because biomedical model is also paternalistic and focus on disease rather than on a person as whole, individuals are often prevented from understanding their roles and acquiring the abilities needed to manage their chronic conditions.

Thus, when I embarked on the journey of writing my doctoral thesis, I wanted to approach the topic by challenging the status quo of a biomedical model and therefore giving voices to research subjects. I wanted to provide them with the opportunity to help us to understand their needs, motivations and struggles of having a chronic wound while navigating in a social world. I also wanted to consider questions, such as how do healthcare providers might better meet the needs of individuals with chronic wounds (e.g. diabetic foot ulcer) if they looked beyond just the illness itself? I believed that to address my goals I needed to use a methodological approach that would view individuals in society as active subjects working collectively and sharing experiences to re-construct their world and realities. I was fortunate enough to have had two amazing co-supervisors (Drs. Tregunno and Camargo Plazas) who guided me through this process of learning about a variety of methodologies and choosing one that would be the best fit to my research questions and philosophical assumptions. With their guidance I embarked on the journey of writing a grounded theory (GT) study. They provided me directions and allowed me to make a decision about which version of GT to use in my study.

After reading and learning about the main versions of grounded theory and doing a literature review, I noticed sparse studies focusing on individuals’ needs, motivations and struggles to manage their chronic wounds. There was no published study showing a theoretical model depicting the factors that influence individual’s engagement in self-management of a multifaceted chronic wounds such as diabetic foot ulcer (DFU). In response to this research gap, and to contribute knowledge on how to improve self-management and health outcomes of DFU from patients’ unique experience, I decided to use constructivist grounded theory to understand the processes of engagement in self-management described by individuals with active DFU, and develop a theoretical model depicting the factors that influence their ability to actively engage in their own care (Figure).

Ultimately, I want to invite healthcare providers, particularly, wound care professionals and policy makers, to take a look in this paper as it uniquely uncovers inadequacies in diabetes knowledge and inequalities in access to wound care services and resources for individuals living with DFU. These findings provide a foundation to guide clinicians and policy makers in improving diabetes care in order to reduce the risk of developing DFU in the first place, and ultimately, to improve self-management of diabetes and DFU. Finally, these findings also highlight the need to ensure the necessary self-management education program, services, and resources to facilitate individuals’ engagement in self-management of a multifaceted condition are in place.

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