Examining the Changes in Patient Adherence to Diabetic Footwear Using a Grounded Theory Approach

Abstract Background Foot ulceration is one of the most debilitating complications of diabetes, often leading to further injury and eventual amputation. Specialized prescriptive footwear is a common modality for treatment and prevention of diabetic foot ulcers. However, footwear adherence is abysmally low in most cases, nullifying the therapeutic efficacy of this critical treatment. Little research has been done to ascertain the motivations and perspectives of those who utilize diabetic footwear, with this being the first qualitative study in the United States that seeks to understand the perspectives of those suffering from foot ulceration on therapeutic footwear. Methods In-depth interviews with fifteen diabetic individuals on their preferences and experiences with prescriptive footwear were conducted. A coding scheme was then iteratively generated and applied to interview transcripts using a grounded theory approach in order to elucidate key concepts. Results Three main categories by which patients evaluated prescription footwear emerged: style, utility, and efficacy. In the interviews, many common themes were found in the temporal progression of an individual’s attitude towards diabetic footwear . Based on these findings we found that there is a tripartite progression model of patient attitudes towards footwear, with individuals first emphasizing style early in the disease course, then footwear comfort, and, after a watershed moment such as an amputation, therapeutic efficacy. Conclusions This study has important implications for the design of future diabetic footwear. Using the tripartite model of progression, clinicians can tailor therapy to match patient preferences through the course of their disease, maximizing adherence.