Dataset Information

Intervention planning for the REDUCE maintenance intervention: a digital intervention to reduce reulceration risk among patients with a history of diabetic foot ulcers.

ABSTRACT:

Objectives

To develop a comprehensive intervention plan for the REDUCE maintenance intervention to support people who have had diabetic foot ulcers (DFUs) to sustain behaviours that reduce reulceration risk.

Methods

Theory-based, evidence-based and person-based approaches to intervention development were used. In phase I of intervention planning, evidence was collated from a scoping review of the literature and qualitative interviews with patients who have had DFUs (n=20). This was used to identify the psychosocial needs and challenges of this population and barriers and facilitators to the intervention's target behaviours: regular foot checking, rapid self-referral in the event of changes in foot health, graded and regular physical activity and emotional management. In phase II, this evidence was combined with expert consultation to develop the intervention plan. Brief 'guiding principles' for shaping intervention development were created. 'Behavioural analysis' and 'logic modelling' were used to map intervention content onto behaviour change theory to comprehensively describe the intervention and its hypothesised mechanisms.

Results

Key challenges to the intervention's target behaviours included patients' uncertainty regarding when to self-refer, physical limitations affecting foot checking and physical activity and, for some, difficulties managing negative emotions. Important considerations for the intervention design included a need to increase patients' confidence in making a self-referral and in using the maintenance intervention and a need to acknowledge that some intervention content might be relevant to only some patients (emotional management, physical activity). The behavioural analysis identified the following processes hypothesised to facilitate long-term behaviour maintenance including increasing patients' skills, self-efficacy, knowledge, positive outcome expectancies, sense of personal control, social support and physical opportunity.

Conclusions

This research provides a transparent description of the intervention planning for the REDUCE maintenance intervention. It provides insights into potential barriers and facilitators to the target behaviours and potentially useful behaviour change techniques to use in clinical practice.

SUBMITTER: Greenwell K

PROVIDER: S-EPMC5961606 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Intervention planning for the REDUCE maintenance intervention: a digital intervention to reduce reulceration risk among patients with a history of diabetic foot ulcers.

Greenwell Kate K Sivyer Katy K Vedhara Kavita K Yardley Lucy L Game Frances F Chalder Trudie T Richards Gayle G Drake Nikki N Gray Katie K Weinman John J Bradbury Katherine K

BMJ open 20180518 5

<h4>Objectives</h4>To develop a comprehensive intervention plan for the REDUCE maintenance intervention to support people who have had diabetic foot ulcers (DFUs) to sustain behaviours that reduce reulceration risk.<h4>Methods</h4>Theory-based, evidence-based and person-based approaches to intervention development were used. In phase I of intervention planning, evidence was collated from a scoping review of the literature and qualitative interviews with patients who have had DFUs (n=20). This wa ...[more]

PMID: 29779008

Similar Datasets

Project description:BackgroundIndividuals living with diabetes run an increased risk of developing diabetic foot ulcers (DFUs), leading to high costs to society and reduced quality of life for the individual. Regular screening is important to avoid complications.AimTo evaluate patients' and clinicians' experiences of using a digital tool, the D-Foot, in the screening of risk factors for developing DFUs. The secondary aims were to investigate whether patients had had their feet examined by a nurse or doctor during the past year, had been referred to podiatry and whether patients had received information about self-care.MethodsA prospective study was carried out, comprising 90 patients with diabetes visiting a Department of Prosthetics and Orthotics (DPO). Two Certified Prosthetists and Orthotists (CPOs) were included, and they assessed foot status and the risk of developing DFUs with the D-Foot software, prior to prescribing footwear. The quality of services at the DPO was assessed by the patients using the Orthotics and Prosthetics Users' Survey (OPUS). The CPOs answered the System Usability Scale (SUS) before and after the study to assess the usability of the D-Foot.ResultsNo patient had risk grade 1. One (1%) patient had risk grade 2, 78 (87%) patients had risk grade 3 and 11 (12%) patients had risk grade 4. Patients reported high levels of satisfaction on eight of ten OPUS items and the two items with lower scores were not related to the use of the D-Foot. The two CPOs reported levels above the mean regarding usability both before (77.5 and 90) and after (70 and 97.5) using the D-Foot.ConclusionsPatients expressed a high level of satisfaction with the services when their feet were examined with the D-Foot prior to the provision of footwear. The CPOs found that the D-Foot system was usable. Several comments were made by patients and CPOs and will support the future development and testing of the D-Foot. There is a need to increase referrals for preventive podiatry and improve information on self-care for patients at risk of DFUs.Trial registrationClinicalTrials.gov ID: NCT04054804.

Project description:ObjectiveMultiple single-center studies have reported significant reductions in major amputations among patients with diabetic foot ulcers after initiation of multidisciplinary teams. The purpose of this study was to assess the association between multidisciplinary teams (ie, two or more types of clinicians working together) and the risk of major amputation and to compile descriptions of these diverse teams.MethodsWe searched PubMed, Scopus, Cumulative Index to Nursing and Allied Health, and Cochrane Central Register of Controlled Trials from inception through May 24, 2019 for studies reporting the association between multidisciplinary teams and major amputation rates for patients with diabetic foot ulcers. We included original studies if ≥50% of the patients seen by the multidisciplinary team had diabetes, they included a control group, and they reported the effect of a multidisciplinary team on major amputation rates. Studies were excluded if they were non-English language, abstracts only, or unpublished. We used the five-domain Systems Engineering Initiative for Patient Safety Model to describe team composition and function and summarized changes in major amputation rates associated with multidisciplinary team care. A meta-analysis was not performed because of heterogeneity across studies, their observational designs, and the potential for uncontrolled confounding (PROSPERO No. 2017: CRD42017067915).ResultsWe included 33 studies, none of which were randomized trials. Multidisciplinary team composition and functions were highly diverse. However, four elements were common across teams: teams were composed of medical and surgical disciplines; larger teams benefitted from having a "captain" and a nuclear and ancillary team member structure; clear referral pathways and care algorithms supported timely, comprehensive care; and multidisciplinary teams addressed four key tasks: glycemic control, local wound management, vascular disease, and infection. Ninety-four percent (31/33) of studies reported a reduction in major amputations after institution of a multidisciplinary team.ConclusionsMultidisciplinary team composition was variable but reduced major amputations in 94% of studies. Teams consistently addressed glycemic control, local wound management, vascular disease, and infection in a timely and coordinated manner to reduce major amputation for patients with diabetic foot ulcerations. Care algorithms and referral pathways were key tools to their success.

Dataset Information

Intervention planning for the REDUCE maintenance intervention: a digital intervention to reduce reulceration risk among patients with a history of diabetic foot ulcers.

Objectives

Methods

Results

Conclusions

Publications

Intervention planning for the REDUCE maintenance intervention: a digital intervention to reduce reulceration risk among patients with a history of diabetic foot ulcers.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets