Grant: Travel Awards - Institute Community Support

Background: Worldwide, diabetic foot ulcer (DFU) is the main cause of emergency room admission, long hospital stays, and high mortality rates for patients with diabetes. Until recently, efforts to manage DFU have focused primarily on biomedical aspects of healthcare, including pharmacological and technical approaches rather than on patient engagement in self-management. The purpose of this doctoral study was to develop the first theory that explains the processes of engagement in self-management for individuals with DFUs and to identify the factors that facilitate or limit such engagement. Methods: A constructivist grounded theory, informed by Charmaz, was used to guide the study design. Theoretical sampling and intensive semi-structured interviews were conducted with thirty individuals with active DFU attending a wound care clinic in southeastern Ontario, Canada, between May and August 2017. Results: The study results draw attention to the complexity that exists for individuals with DFU to balance life and manage their chronic condition. The processes of engagement in SM of DFU involved five phases: 1) perceiving illness, 2) noticing foot changes, 3) realizing seriousness, 4) beginning to learn about SM, and 5) engaging in SM. Engagement is a complex and multifactorial process. Study participants describe factors such as aging and/or living with multiple chronic conditions, motivation, self-efficacy, self-management knowledge, self-management support, and access to services and resources. Conclusion: The results of my study showed the pathway participants used to learn about self-management practices and how engagement in day-to-day management of DFU occurred. The study has also helped to uncover inequities in accessing formal SM education and specialized services and resources for this population, inequities that in turn contribute to inform practice, education, and health policy.