‘What ever I do it’s a lost cause.’ The emotional and behavioural experiences of individuals who are ulcer free living with the threat of developing further diabetic foot ulcers: a qualitative interview study

Abstract

OBJECTIVE: Individuals who have had one diabetic foot ulcer (DFU) are at high risk for developing further DFUs. This study was designed to examine the emotional and behavioural consequences of living with this heightened risk of re-ulceration. PARTICIPANTS AND SETTING: Fifteen women and men living in south-west England were interviewed at home or at the university by an academic psychologist. DESIGN: Interviews were audiotaped and transcribed verbatim. Thematic analysis using the constant comparative method was employed for data analysis. RESULTS: Participants reported having little perceived control in preventing further DFUs. This lack of control was associated with a range of negative emotions including fears and worries about developing further foot ulcers, amputation and guilt for the past neglect. Tensions were present between participants' beliefs and reported behaviours, that is, what they felt they ought to be doing and what they were actually doing to care for their feet; most engaged in 'strategic adherence', that is, conducting a trade-off between living a normal life and following foot-care advice. CONCLUSION: A lack of perceived control appears central to the emotional and behavioural responses of individuals living with the threat of re-ulceration. We propose that these responses may serve to increase individuals' risk of re-ulceration and that these 'risk factors' should be considered part of the management of this patient group.