Patients' Journey Toward Engagement in Self-Management of Diabetic Foot Ulcer in Adults With Types 1 and 2 Diabetes: A Constructivist Grounded Theory Study.

OBJECTIVES

Our aim in this study was to develop the first theory that could explain the processes of engagement in self-management for adults with diabetic foot ulcer (DFU).

METHODS

A constructivist grounded theory, informed by Charmaz, and symbolic interactionism were used to guide the study design.

RESULTS

The findings from 30 study participants with active DFU draw attention to the complexity that exists for individuals seeking to balance life and manage their diabetes and DFU. The categories/phases and set of associated concepts comprise the theory known as The Journey Toward Engagement in Self-Management. This theory consists of 5 phases: 1) perception of illness, 2) noticing foot changes, 3) realizing seriousness, 4) beginning to learn about self-management and 5) engaging in self-management. The theory's phases describe the processes of engagement in self-management from participants' unique experience of living and managing DFU.

CONCLUSIONS

The results show the pathways taken by participants to learn about self-management practices and how engagement in day-to-day management of DFU occurred. Engagement in self-management of an active DFU is complex and a developmental process that differs from participant to participant and changes over time. Although most participants preferred to take a more passive role in self-management of DFU (seen in phase 4), others demonstrated confidence to advance to another stage (seen in phase 5). At the advanced stage, they took an active role in self-management by expressing their needs and preferences, and were involved in their own care and decision-making related to treatment options.