Barriers to preventive and curative foot care behaviors in person with diabetes. Suggestions for therapeutic patient education

Aim: The purpose of this study is to explore barriers most likely to interfere with person with diabetes’ preventive and curative behaviors with regard to their feet and to offer suggestions for patient education based on this analysis. Methods: Thirty persons with Type 2 diabetes mellitus at high risk for foot problems were interviewed. A concept map was constructed and supplemented by questions exploring disease representations, locus of control, perceived severity, perceived competence, and patient education needs. A comparative analysis was performed between two groups: seventeen patients with recurrence of foot ulcers, and 13 patients with no recurrence. Results: Patients with recurrence were more likely than those without recurrence to emphasize the negative impact of the ulcer on their daily live, their locus of control was more external than that of patients without recurrence. Patients with no recurrence demonstrated a “preventive attitude” characterized by the fact that they were more likely to emphasize preventive care on their concept maps than were patients with recurrence. They also expressed greater perceived competence in avoiding and detecting the first signs of foot ulcers than did patients with recurrence. Conclusion: Based on the observed differences between patients with and without recurrences, we propose some improvements in patient education programs, focusing more on increasing patients’ understanding of the mechanisms of foot ulcers, helping them develop a preventive attitude, and increasing their perceived competence in avoiding ulcers.