Needs and preferences regarding a mobile application to support diabetic foot self-care.

OBJECTIVE: To identify the needs and preferences of individuals with type 2 diabetes regarding the functionalities and characteristics for a mobile application to support foot self-care. METHOD: Qualitative research with 16 individuals diagnosed with type 2 diabetes recruited during clinical care at a university hospital in Porto, Portugal. Data were collected through semi-structured interviews between March and June 2022 and analyzed using inductive content analysis. RESULTS: Three categories and nine subcategories were identified. Categories included informational needs, essential functionalities for foot health self-care, and user-relevant experience. The preference for objective, limited data input, flexible, and customizable applications was an important factor influencing technology engagement. CONCLUSION: The research highlighted a preference for customizable and flexible applications, aiding nurses in creating solutions that transform care delivery and enhance the quality of life for individuals living with diabetes.

The Impact of Diabetic Foot Ulcer on Individuals' Lives and Daily Routine: A Qualitative Study Informed by Social Constructivism and Symbolic Interactionism Frameworks.

PURPOSE: The purpose of this study was to explore the impact of diabetic foot ulcer (DFU) on individuals' lives and daily routines. DESIGN: Qualitative design informed by social constructivism and symbolic interactionism frameworks. SUBJECTS AND SETTING: The sample comprised 30 individuals attending a wound care clinic in Southeast Ontario, Canada. Most participants (n = 17) were between the ages of 65 and 92 years, were male (n = 20), married (n = 21), living with their family (n = 23), and had completed high school (n = 26). METHODS: One-to-one semistructured interviews were conducted by the first author until saturation of each emerging theme was achieved. Interviews were audio-recorded and lasted from 45 to 90 minutes. Data collection and analysis occurred simultaneously and included intensive semistructured interviews, field notes, and researcher's journal. RESULTS: Participants with DFUs were found to perceive a "sense of life change," impacting their lives across physical, psychological, and social spheres. They reported 4 key themes indicating that DFUs were (1) limiting their outings; (2) restricting leisure activities; (3) impacting personal and social life; and (4) contributing to emotional fluctuations. CONCLUSION: Sense of life changes resulting from DFUs were associated with participant reporting loss of freedom and enjoyment. These findings underscore the need for holistic support for patients with DFUs that simultaneously address physical, psychological, and social needs and areas of impact.

CHRONIC COMPLICATIONS OF DIABETES AND QUALITY OF LIFE.

The course of diabetes is marked by the development of chronic complications that, in addition to affecting health, also affect the quality of life of patients. The purpose of this study was to compare the quality of life of patients with type 2 diabetes based on their chronic complications. The study, which was conducted from March 2019 until March 2020, included 382 diabetic patients, specific data from medical records, and the application of the World Health Organization Quality of Life-Brief questionnaire. There were more men than women included in the study, with the majority of respondents belonging to the age group of 61 to 70 years. In the quality-of-life assessment, the mean value of physical functioning was 57.14 (42.86-71.43), psychological functioning was 66.67 (54.17-79.17), social functioning 66.67 (50.00-75.00), and environmental functioning was 68.75 (50.00-75.00). The domains of social functioning were lowest in patients with diabetic retinopathy and neuropathy, while the physical functioning domains were rated lowest in patients with diabetic nephropathy, diabetic foot ulcer, and multiple chronic complications. All domains were rated lowest by patients with multiple complications and highest by those without any complications. In conclusion, differences in the assessment of quality of life of diabetic patients depend on the type of chronic complication.

Psychological and Cognitive Barriers to Diabetes-Related Foot Complication Treatment: Clinicians' Perspectives.

This study investigated clinicians' perspectives about cognitive functioning and mental health in individuals with diabetes-related foot complications (DRFCs), and how these impact the clinicians' treatment of the patients' conditions. Psychological and cognitive impairments may be more pronounced in individuals with DRFCs compared with the general diabetes mellitus population. Understanding these factors will identify potential barriers to DRFC treatment adherence and effective disease self-management. Fourteen multidisciplinary clinicians (Meanage = 37.86 years; standard deviation = 9.26; range = 27-51) were recruited from a metropolitan hospital diabetic foot unit. Semistructured interviews were conducted with each clinician, followed by the completion of a brief quantitative questionnaire. Interview data were analyzed thematically. Six themes that encompassed factors affecting DRFC treatment were identified: (1) psychological and cognitive characteristics; (2) the person in the environment; (3) illness and self-identity; (4) burden of chronic disease; (5) engaging with treatment; and (6) the clinician and health system response. Quantitative questionnaire results coincided with qualitative findings, with endorsement of global psychological and cognitive impairment in individuals with DRFC, which considerably affected their ability to engage in treatment. From the perspectives of clinicians working with patients with DRFCs, psychological, cognitive, and social factors have a considerable influence on DRFC treatment and self-management. Further investigation of these factors and their interrelationships is necessary to enhance treatment adherence in individuals with DRFCs.

Acceptance of illness, quality of life and nutritional status of patients after lower limb amputation due to diabetes mellitus.

INTRODUCTION: Diabetes mellitus is one of the most common chronic diseases with a high number of sufferers worldwide. Diabetic neuropathy and diabetic angiopathy lead to serious infectious complications which are very difficult to combat and may finally lead to the amputation of a lower limb. The aim of the study was to evaluate the quality of life, the level of acceptance of the illness and the nutritional status of patients after lower limb amputation due to diabetes. METHODS: Ninety-nine patients (23 men and 76 women) were enrolled into the study. They had all undergone lower limb amputation due to diabetic foot and were treated in the Department of General and Oncological Surgery. The following questionnaires were used: the WHO Quality of Life-BREF (WHOQOL-BREF), the Mini Nutritional Assessment (MNA), the Acceptance of Illness Scale (AIS) and the anonymous specific socio-demographic characteristics questionnaire. RESULTS: The diabetes-related amputees were revealed to have a higher QoL within the social domain (mean score 64.48), an intermediate QoL - within the environmental domain (mean score 63.04) and the mental domain (mean score 59.61), and a lower QoL - within physical (somatic) domain (mean score 54.69). There was no statistical correlation between genders or between all the domains of QoL (P > 0.05). The mean MNA score was 22.66, which means that patients were at risk of malnutrition. There were statistical differences between women and men as regards nutritional status (P = 0.034). The mean AIS score was 27.65 (27.09 women and 29.48 men), which means that the respondents accept their disease. There was no statistical correlation between gender and the acceptance of the disease (P = 0.288). There was not statistical correlation between age and QoL (P > 0.05). There were statistical differences between age and nutritional status (P < 0.05), and between age and acceptance of the illness (P = 0.044). CONCLUSIONS: The better the quality of life was in all the domains, the better the level of acceptance of illness was. The less malnourished the patient was, the better their quality of life was in all the domains.

Diabetic foot social representations about the experiences of people with diabetes mellitus / Pie diabético: representaciones sociales sobre la experiencia de personas con diabetes mellitus / Pé diabético: representações sociais sobre as vivências das pessoas com diabetes mellitus

ABSTRACT Objective: to understand the social representations about the experiences of people with diabetic foot. Method: a qualitative study, based on the Theory of Social Representations, carried out with 28 participants, in reference services for the treatment of diabetic foot in São Luís, Maranhão, Brazil, from February to May 2019. Data collection took place through semi-structured interviews, a script to characterize the sociodemographic and clinical profile and a field diary. Content analysis was applied with the support of a qualitative data analysis software for categorization. Results: the results made it possible to identify two categories: experiencing diabetic foot, with the respective subcategories, and social responses to diabetic foot. The first category includes the following subcategories: cognitive aspects, psycho-affective aspects, social aspects and morality. The social representations of diabetic foot were based on a painful daily experience, with reference to functional loss, dependence on others and difficulty performing activities that were previously usual. Conclusion: the study made it possible to assert that diabetic foot is an object of social representation, showing how people build, connect and apply knowledge. The research constitutes a support tool for the care of people with diabetic foot, as it assists in the planning of interventions with impacts on the development of representations that generate positive health behaviors, from the perspective of foot self-monitoring.

RESUMEN Objetivo: comprender las representaciones sociales sobre la experiencia de personas que padecen pie diabético. Método: estudio cualitativo, basado en la Teoría de las Representaciones Sociales, realizado con 28 participantes, en servicios de referencia en tratamiento del pie diabético, en São Luís, Maranhão, Brasil, de febrero a mayo de 2019. La recolección de datos se realizó a través de entrevistas semiestructuradas, guía para caracterizar el perfil sociodemográfico y clínico y diario de campo. El análisis de contenido se llevó a cabo con el soporte de un software de análisis de datos cualitativos para la categorización. Resultados: los resultados permitieron identificar dos categorías: la experiencia de vivir con pie diabético, con sus respectivas subcategorías, y respuestas sociales al pie diabético. En la primera categoría, se encuentran las subcategorías: Aspectos cognitivos, Aspectos psicoafectivos, Aspectos sociales y moralidad. Las representaciones sociales del pie diabético se basaron en una experiencia cotidiana dolorosa, con referencia a la pérdida funcional, la dependencia de los demás y la dificultad para realizar actividades que antes eran habituales. Conclusión: el estudio permitió afirmar que el pie diabético es un objeto de representación social y demuestra cómo las personas construyen, conectan y aplican conocimientos. La investigación se constituye en herramienta de apoyo para el cuidado de personas con pie diabético, puesto que contribuye en la planificación de intervenciones que impacten en el desarrollo de representaciones que generen conductas positivas de salud, desde la perspectiva del autocuidado de los pies.

RESUMO Objetivo: compreender as representações sociais sobre as vivências das pessoas com a condição de pé diabético. Método: estudo qualitativo, fundamentado na Teoria das Representações Sociais, realizado com 28 participantes, em serviços de referência no tratamento de pé diabético, em São Luís, Maranhão, Brasil, de fevereiro a maio de 2019. A coleta dos dados ocorreu por meio de entrevistas semiestruturadas, roteiro para caracterização do perfil sociodemográfico e clínico e diário de campo. Aplicou-se análise de conteúdo com suporte do software de análise qualitativa de dados para categorização. Resultados: os resultados possibilitaram identificar duas categorias: vivenciando o pé diabético, com as respectivas subcategorias, e respostas sociais ante o pé diabético. Na primeira categoria, têm-se as subcategorias: aspectos cognitivos, aspectos psicoafetivos, aspectos sociais e moralidade. As representações sociais do pé diabético se sustentaram em vivência cotidiana penosa, com referência à perda funcional, dependência de terceiros e dificuldade de realizar atividades antes habituais. Conclusão: o estudo possibilitou afirmar que o pé diabético é um objeto de representação social, demonstrando o modo como as pessoas constroem, conectam e aplicam conhecimentos. A investigação constitui ferramenta de apoio ao cuidado da pessoa com pé diabético, por auxiliar no planejamento de intervenções com impactos na elaboração de representações que gerem comportamentos positivos em saúde, na perspectiva da autovigilância dos pés.

Calidad de vida y cicatrización en los pacientes con úlceras de pie diabético en el ámbito latinoamericano / Healing and quality of life and healing in patients with diabetic foot ulcers in the Latin American area

Introducción: Las úlceras del pie diabético (UPD) son una complicación común de la diabetes, y no solo un importante factor de mortalidad, e influyen negativamente en la calidad de vida de las personas con diabetes. Objetivos: Establecer la relación entre la evolución de la cicatrización de las UPD mediante la escala RESVECH 2.0 y la calidad de vida de los pacientes con UPD a partir de la escala Diabetic Foot Ulcer Scale (DFS-SF) en distintos centros de salud de países latinoamericanos. Metodología: Estudio observacional prospectivo longitudinal de medidas repetidas de una cohorte de pacientes con UPD. Se analizó el impacto que las UPD y su tratamiento producen sobre la calidad de vida relacionada a la salud (CVRS) mediante la escala DFS-SF y la relación entre la cicatrización (escala RESVECH 2.0) en el contexto latinoamericano (Argentina, México, Perú, Uruguay). Resultados: La puntuación global para los distintos momentos del estudio mostró un incremento en la CVRS desde el inicio hasta las 8 semanas. Las variables que más influyeron fueron: el tipo de país, las características del cuidador y el tratamiento de la diabetes en los distintos momentos del estudio. En cuanto a la CVRS y el proceso de cicatrización, los resultados muestran que existe correlación entre ambas variables (p < 0,0001) en los tres periodos del estudio. Conclusiones: Existe asociación entre la CVRS de los pacientes con UPD, según el tipo de país, el nivel de estudios y el tratamiento de la diabetes en los tres momentos del estudio. El tipo de movilidad física, las características del cuidador y la presencia de amputación son los factores que más influyeron en la cicatrización de los pacientes con UPD. La mejora en la cicatrización influye en la calidad de vida de los pacientes con UPD (AU)

Introduction: Diabetic foot ulcers (UPD, in spanish) are a common complication of diabetes, and not just a major mortality factor, and negatively influence the quality of life of people with diabetes. Objectives: To establish the relationship between the evolution of UPD healing using the RESVECH 2.0 scale and the quality of life of patients with UPD from the Diabetic Foot Ulcer Scale DFS-SF in different health centers in Latin American countries. methodology: Longitudinal prospective observational study of repeated measures of a cohort of patients with UPD. The impact that UPDs and their treatment produce on health-related quality of life (CVRS, in spanish) was analyzed using the DFS-SF Scale and the relationship between healing (Resvech 2.0 scale) in the Latin American context (Argentina, Mexico, Peru, Uruguay). Results: The global score for the different moments of the study showed an increase in CVRS from baseline to 8 weeks. The variables that most influenced were: the type of country, the characteristics of the caregiver and the treatment of diabetes at the different moments of the study. Regarding CVRS and the healing process, the results show that there is a correlation between both variables p <0.0001 in the three periods of the study. Conclusions: There is an association between CVRS of patients with UPD, according to the type of country, the level of education and the treatment of diabetes in the three moments of the study. The type of physical mobility, the characteristics caregiver and the presence of amputation are the factors that most influenced the healing of patients with UPD. The improvement in Scarring influences the quality of life of patients with UPD (AU)

A fact-finding survey on self-efficacy of foot care behaviour in patients with diabetes: Analysis using the Diabetes Study from the Center of Tokyo Women's Medical University 2017 (DIACET 2017).

Aim: We aimed to determine the association between self-efficacy of foot care behaviour and chronic complications in Japanese patients with diabetes. Methods: We conducted a cross-sectional study based on a questionnaire survey of 4571 patients with type 1 and type 2 diabetes who had (a) given consent to participate in the Diabetes Study from the Center of Tokyo Women's Medical University: DIACET 2017, and (b) completed all the questions of the Japanese Version of Foot Care Confidence Scale (J-FCCS), consisting of 12 statements. Results: A greater proportion of respondents answered that they were not confident in determining the condition of corns and/or calluses and the condition of toenails. The J-FCCS total scores of the patients with retinopathy (p <.001) and numbness or pain in the feet (p <.001) were significantly lower than those of the patients without these complications. In both the multiple regression analysis and logistic regression analysis, lower J-FCCS was significantly associated with retinopathy and numbness or pain in the feet. Conclusion: Foot care education that emphasizes a psychological approach in improving confidence associated with foot self-care is important for patients with advanced complications of diabetes.

Knowledge and practice of diabetic foot care - A scoping review.

BACKGROUND AND AIMS: This review aims to systematically map global evidence on foot-care knowledge and practices in relation to diabetes mellitus (DM) and identify areas that need further research. METHODS: Database searches were undertaken using Google Scholar, Medline (PubMed), Academic Search Complete (EBSCOhost), and Medline (EBSCOhost). Studies were initially sought by title and focused on knowledge of diabetic foot ulcer burden. The framework by Arksey and O'Malley and the PRISMA-SCR guidelines were used to guide the methodology. The themes explored were principles of foot-care knowledge and practice and these were reported using content analysis. The mixed-methods appraisal tool (MMAT) was employed to appraise the quality of the primary studies. RESULTS: Fifty-eight studies published between 2008 and 2018 met the inclusion criteria. Participants in various studies had varying degrees of foot-care knowledge and practice, including foot inspection, foot hygiene, glycaemic control, and foot protection. Many people had knowledge of the various aspects of foot care but fewer practiced proper foot care. The MMAT showed the majority of the articles to be of high quality. CONCLUSIONS: Level of foot-care knowledge and practice varied in the studies. A need for intervention on foot care was highlighted.

I fear COVID but diabetic foot (DF) is worse: a survey on patients' perception of a telemedicine service for DF during lockdown.

AIMS: To evaluate the patients' perceptions of telemedicine visits during COVID-19 lockdown and their level of anxiety about COVID and diabetic foot (DF). METHODS: In May 2020, we contacted by phone all the patients who underwent in March and April to remote monitoring visits for DF during the lockdown for COVID-19, with a structured interview, focusing on their perceptions about telemedicine service for DF and on the anxiety toward COVID and DF. RESULTS: We analyzed 257 remote monitoring visits in 211 patients. Two hundred and six patients answered the follow-up interview; 177 patients (85.9%) remembered the monitoring visit, 140 (67.9%) the health care professional and 181 patients (87.9%) the reason of contact; 169 patients were alone during the visit, 37 with a relative. Patients judged useful both the monitoring during pandemic (4.35 ± 0.28 on a maximum of five) and the possibility to continue after the lockdown (4.34 ± 0.23 on a maximum of five). Eventually, we observed that DF patients were more worried by DF than by COVID on a scale from 0 (not fear at all) to 5 (terrified) (4.79 ± 0.05 vs. 3.27 ± 1.03, p < 0.05). This difference was higher in previously ulcerated patients (4.84 ± 0.03 vs. 3.03 ± 1.13, p < 0.05) and even more in amputees (4.93 ± 0.03 vs. 2.73 ± 1.21, p < 0.05). CONCLUSIONS: DF patients appreciated televisits during lockdown and the continuation of this service after its end. In this context DF prevails on COVID in the worries of patients, especially if they are recurrent ones.

Anxiety, depression and their associated risk factors among patients with diabetic foot ulcer: A two center cross-sectional study in Jordan and Saudi Arabia.

BACKGROUND AND AIMS: To determine and analyze the factors related to anxiety and depression in patients having diabetic foot ulcer (DFU). METHODS: This two-center, cross-sectional study was conducted among 250 patients with DFU, who were receiving treatment in the outpatient diabetes foot care clinic at Prince Sultan Military Medical City, Saudi Arabia and National Center for Diabetes, Endocrinology and Genetics, Jordan. Employing the Hospital Anxiety and Depression Scale (HADS), the anxiety and depression levels of the study population were measured. The demographic variables were also recorded. RESULTS: Females displayed significantly higher anxiety (p = 0.032) and depression levels (p = 0.043); and those who were unmarried showed higher anxiety (p = 0.042). School educated patients showed reduced degrees of anxiety (p = 0.023) and depression (p = 0.003) and college educated showed reduced anxiety (p = 0.047) compared to uneducated. Compared to patients on treatment with diet, a significant decline was found in depression (p = 0.034) levels among orally treated patients. Compared to patients on oral medication, patients with oral and insulin treatments revealed higher depression (p = 0.026). Higher-income patients showed a significant decline for anxiety (p = 0.004). Patients who were past smokers had higher anxiety (p = 0.046) than current and never had been smokers. Higher anxiety (p = 0.017) was observed in patients having higher HbA1c levels, similarly, patients with three diabetes-related complications showed higher levels of anxiety (p = 0.001) and depression (p = 0.001). CONCLUSION: Female gender, lower education levels, patients on oral and insulin treatments, low income, high HbA1c levels and patients experiencing a higher number of diabetes-related complications showed either higher anxiety or depression levels.

Self care practices and psychological distress among diabetic patients in Manipur during COVID-19: A scenario from the North East.

BACKGROUND AND AIM: Uncontrolled diabetes has emerged as one of the major risk factors for mortality in patients with coronavirus disease (COVID-19). Physical inactivity, alterations in dietary habits, and inability to seek guidance from the physician are some of the contributing factors. This study aims to assess the self-care practices and psychological distress during the pandemic among diabetic patients visiting the institute's out patient department. METHOD: A convenient sampling method was used to recruit subjects from a representative clinical sample using validated scales like the Summary of Diabetes Self-Care Activities (SDSCA) and Kessler Psychological Distress Scale (K10). RESULT: The study enrolled a total of 108 subjects with the mean age being 56.3 years. The everyday healthy eating plan was followed by 76.85% (N = 83) subjects and daily physical activity for at least 30 min performed by 50% (54) subjects. Only 12.04% (13) subjects tested their blood sugar and 6.48% (7) respondents checked their feet daily. There was no significant difference found between the SDSCA and psychological distress based on socio-demographic variables. CONCLUSION: Participants in this study typically reported a good level of self-care behavior particularly for diet followed by exercise whereas the self-care behavior was not adequate for foot care and blood-glucose testing. People were not too anxious about COVID-19. This study highlighted the fact that people with diabetes should monitor their blood sugar levels more often along with their foot care.

Patient perceptions of phage therapy for diabetic foot infection.

Infections of diabetic foot ulcers are common, generally recalcitrant and often complicated by antibiotic resistance. Alternative antimicrobial strategies are needed. Phage therapy is a promising alternative that is being rediscovered. Despite phage therapy's 100-year history, there have been no investigations into patient thoughts and concerns. This study aimed to explore patient awareness of and concern about antibiotic resistance and gain insight into the perceptions of phage therapy among a patient group that could potentially benefit from phage therapy. Patients with an active or resolved (healed or amputated) diabetic foot ulcer were eligible to participate. A survey was distributed digitally to eligible patients across Scotland via the NHS Research Scotland Diabetes Network and hard copies were available in diabetic foot clinics at the Royal Infirmary of Edinburgh and Queen Elizabeth University Hospital, Glasgow. A focus group of five survey respondents was held in Glasgow. Fifty-five survey responses were obtained. There was a high level of awareness (76.4%; N = 55) and concern (83.3%; N = 54) about antibiotic resistance. While largely aware of viruses, most patients had not heard of phage or phage therapy. Patients were no more concerned about phage than antibiotic therapy, with most suggesting more information could alleviate any concerns. Patient acceptability of phage therapy was high, a finding confirmed by the focus group. Patients are concerned about antibiotic resistance and supportive of 'new' antimicrobials. We have demonstrated that patients are supportive, enthusiastic and accepting of phage therapy. Although 'Western' phage therapy remains in its infancy, an understanding of patient ideas, concerns and expectations will be important in eventually shaping and successfully reintroducing phage therapy.

Quality of life assessment in chronic wound patients using the Wound-QoL and FLQA-Wk instruments.

OBJECTIVES: To evaluate changes in the quality of life of patients with chronic wounds. METHODS: Quantitative research with a cross-sectional design performed with 100 patients with chronic wounds from a university hospital and a Basic Health Unit in southern Brazil. The mean values of the domains of the instruments Wound Quality of Life (Wound-QoL) and Freiburg Life Quality Assessment Wound were compared with sociodemographic variables of age, sex and education. RESULTS: The average age of the participants was 60.98 years old; 41% (n = 41) had diabetic ulcers and 83% (n = 83) treated the wounds for more than 24 months. The total quality of life value was below the mean with 37.50/100 with (Wound-QoL) and 44.20/100 with (FLQA-Wk). The variables of gender, and educational level were not correlated with either of the two instruments used to assess the quality of life. The age variable was significantly correlated with the satisfaction item of the FLQA-Wk. CONCLUSIONS: The quality of life of patients with chronic wounds was considered poor. The age variable was correlated with the satisfaction domain, showing that the older the age, the lower the satisfaction. The use of instruments to evaluate the quality of life of patients with chronic wounds may help an effective treatment plan.

Psychometric evaluation of the Farsi version of the diabetes foot self-care bahavior scale.

BACKGROUND: Diabetes foot self-care is one of the self-management behaviors of diabetic patients leading to a reduction in the incidence of pressure ulcers and amputation. Having a valid, reliable, simple and comprehensive tool is essential in measuring the self-care behavior of diabetic patients. The aim of this study was to evaluate the psychometric properties of the Farsi version of the diabetes foot self-care bahavior scale (DFSBS) in Iran. METHODS: In this cross-sectional and methodological study, 500 patients with type 2 diabetes were recruited by convenience sampling. Construct validity was assessed by exploratory factor analysis (over 300 patients) and confirmatory factor analysis (over 200 patients). Internal consistency was calculated by Cronbach's alpha coefficient and its stability was calculated by intraclass correlation coefficient (ICC). RESULTS: In the exploratory factor analysis, two self-care factors related to feet and shoes were extracted which had specific values of 38.49 and 1.24, respectively, and were able to account for 56.22% of the total self-care variance of diabetes foot. Confirmatory factor analysis had excellent fit model. The internal consistency and ICC of the whole instrument were 0.83 and 0.791 (95% CI: 0.575-0.925; P < 0.001), respectively. CONCLUSIONS: The Farsi version of DFSBS (F-DFSBS) has good validity and reliability, and due to its appropriate psychometric properties, this tool can be used in future studies.

Predictors of adherence to wearing therapeutic footwear among people with diabetes.

AIMS: People at increased risk of developing diabetic foot ulcers often wear therapeutic footwear less frequently than is desirable. The aims were to identify patient groups prone to nonadherence to wearing therapeutic footwear and modifiable factors associated with adherence. MATERIALS AND METHODS: A questionnaire was mailed to 1230 people with diabetes who had been fitted with therapeutic footwear. Independent variables were categorized into five domains. For each domain, variables that were associated with adherence in a univariate regression analysis were entered into a multiple regression analysis. RESULTS: A total of 429 (34.9%) questionnaires were analyzed. Multiple regression analyses showed significant associations (p < 0.05) between higher adherence and paid employment, current foot ulcer, previous foot ulcer, satisfaction with follow-up, self-efficacy, understanding of lost/reduced sensation as a risk factor for foot ulcerations, visible storage of therapeutic footwear at home, storage of conventional footwear out of sight, consistent choices about which footwear type to wear, and a belief that therapeutic footwear promotes ulcer healing. The five multivariate models explained 2-28% of the variance in adherence, with the strategies for footwear use domain explaining the most. CONCLUSIONS: Patients without paid employment or without foot ulcer experience are more prone to nonadherence. To improve adherence, clinicians should advise patients to store therapeutic footwear in a visible place at home and put conventional footwear away and encourage patients' self-efficacy and habitual use of therapeutic footwear. Future studies should investigate this topic further and explore ways to promote changes in habits. A study limitation was that all variables were self-reported.

Usability of a mobile application on diabetic foot self-care.

OBJECTIVES: to assess the usability of an app prototype for diabetic foot self-care by an end user. METHODS: a descriptive study that uses heuristic assessment of a hybrid app usability. Fifteen users of an outpatient diabetes care service in a capital of Northeastern Brazil participated in the study during April 2018. The usability measurement tool called Smartphone Usability questionnaiRE was applied. RESULTS: the lowest score was 77 and the highest was 112, with an average usability of 96.1 points. Usability was framed in the last two levels, 70 and 8o. Users now strongly agree (level 70) and fully (level 80) with the assessed items, which represents good usability of the apps prototype. CONCLUSIONS: the final product developed focuses on user needs and requirements, which can ensure usability based on effectiveness, efficiency and satisfaction triad.

Turkish Adaptation of Diabetic Foot Ulcer Scale-Short Form.

The purpose of this study was to evaluate the validity and reliability of the Turkish version of the Diabetic Foot Scale-Short Form (DFS-SF). The study was cross-sectional and conducted between January and October 2019 in a diabetic foot council of a university hospital. A total of 194 diabetic foot patients participated in the study. A Patient Identification Form and DFS-SF were used for data collection. Forward and backward translations were used in language validity. Expert opinions were obtained to determine the Content Validity Index. To determine construct validity, exploratory factor analysis and confirmatory factor analysis were used. Cronbach's α internal consistency coefficient, item-scale correlation, and test-retest reliability were used to evaluate reliability. It was found that Content Validity Index was 0.97 (0.86-1.00), the factor loading of scale varied from 0.378 to 0.982, Cronbach's α value varied from 0.81 to 0.94, and item-total correlations were between 0.30 and 0.75. The Turkish version of the DFS-SF was found valid and reliable to measure the quality of life of diabetic foot patients.

Psychosocial and behavioural prognostic factors for diabetic foot ulcer development and healing: a systematic review.

AIM: To investigate whether ulceration, amputation and healing of foot ulcers in people living with diabetes are associated with psychosocial and behavioural factors. METHODS: We searched MEDLINE, Embase, PsychINFO, CINAHL and The Cochrane Library to March 2019 for longitudinal studies with multivariable analyses investigating independent associations. Two reviewers extracted data and assessed risk of bias. RESULTS: We identified 15 eligible studies involving over 12 000 participants. Clinical and methodological heterogeneity precluded meta-analysis, so we summarize narratively. Risk of bias was moderate or high. For ulceration, we found significantly different results for people with and without an ulcer history. For those with no ulcer history, moderate quality evidence suggests depression increases ulcer risk [three studies; e.g. hazard ratio (HR) 1.68 (1.20, 2.35) per Hospital Anxiety and Depression Scale (HADS) standard unit]. Better foot self-care behaviour reduces ulcer risk [HR 0.61 (0.40, 0.93) per Summary of Diabetes Self-Care Activities scale standard unit; one study]. For people with diabetes and previous ulcers, low- or very low-quality evidence suggests little discernible association between ulcer recurrence and depression [e.g. HR 0.88 (0.61, 1.27) per HADS standard unit], foot self-care, footwear adherence or exercise. Low-quality evidence suggests incomplete clinic attendance is strongly associated with amputation [odds ratio (OR) 3.84 (1.54, 9.52); one study]. Evidence for the effects of other psychosocial or behavioural factors on ulcer healing and amputation is very low quality and inconclusive. CONCLUSIONS: Psychosocial and behavioural factors may influence the development of first ulcers. More high quality research is needed on ulcer recurrence and healing. (Open Science Framework Registration: https://osf.io/ej689).