School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK.
Torbay & South Devon NHS Foundation Trust, Torbay Hospital, Lowes Bridge, Torquay, TR2 7AA, UK.
J Foot Ankle Res. 2021 Jan 6;14(1):1. doi: 10.1186/s13047-020-00440-w.
Diabetes related foot complications are increasing in complexity, frequency and cost. The application of self-management strategies can reduce the risk of individuals developing foot complications. The type, range and nature of the literature focusing on interventions that support patients with diabetic foot self-management is unknown. This scoping review aimed to i) identify self-management actions and risky behaviour avoidance strategies within interventions, ii) map the theoretical functions through which these behaviour change interventions have an effect, iii) display gaps in the research.
Arksey and Malley's (2003) 5 stage framework was followed to conduct the scoping study. This methodological framework was selected because it was developed specifically for scoping reviews and therefore offered clear methodological distinction from systematic review methodology. . Databases were searched from inception of the project until June 2020 supplemented by hand searching of reference lists. In total 988 papers were identified. These were independently screened by three reviewers, identifying 19 eligible papers. Data extraction and charting of data was independently conducted by three reviewers to identify study characteristics, self-management actions and risky behaviours. Data was charted against the COM-B (capability, opportunity, motivation, behaviour) model of behaviour to determine intervention function.
In total 25 different foot self-management actions and risk behaviours were classified into three themes; routine self-management, trauma avoidance and warning signs and actions. Inspect feet daily received the most attention. The majority of interventions focused on knowledge and skills, but overlooked taking action and decision making. Intervention mapping identified four primary intervention functions (education, persuasion, training and enablement) used to address deficits in capability, opportunity and motivation that positively improved foot self-management behaviour. No studies targeted first ulcer prevention, and most either did not measure or improve foot health outcomes.
This review charted the evidence for interventions promoting diabetic foot self-management through a theoretical behaviour change perspective. A core set of behaviour change activities and intervention functions associated with positive changes in behaviour were identified. This information will provide researchers with a useful basis for developing self-management interventions.
与糖尿病相关的足部并发症的复杂性、频率和成本都在增加。应用自我管理策略可以降低个体发生足部并发症的风险。支持糖尿病足自我管理患者的干预措施所关注的干预类型、范围和性质尚不清楚。本范围综述旨在：i）确定干预措施中自我管理行为和避免危险行为的策略，ii）通过这些行为改变干预措施起作用的理论功能来绘制图表，iii）展示研究中的空白。
采用阿特金和马利（2003 年）的 5 阶段框架进行范围研究。选择这种方法框架是因为它是专门为范围综述开发的，因此与系统综述方法有明确的方法区别。从项目开始到 2020 年 6 月，数据库进行了搜索，并通过手动搜索参考文献进行了补充。共确定了 988 篇论文。这些论文由三名评审员独立筛选，确定了 19 篇合格论文。三名评审员独立进行数据提取和数据图表绘制，以确定研究特征、自我管理行为和危险行为。根据行为的 COM-B（能力、机会、动机、行为）模型对数据进行图表绘制，以确定干预功能。
共分类为三个主题的 25 种不同的足部自我管理行为和危险行为；常规自我管理、创伤预防和预警及行动。每天检查足部受到的关注最多。大多数干预措施侧重于知识和技能，但忽略了采取行动和决策。干预映射确定了四个主要的干预功能（教育、劝说、培训和赋能），用于解决能力、机会和动机方面的缺陷，从而积极改善足部自我管理行为。没有研究针对首次溃疡预防，并且大多数研究要么没有测量，要么没有改善足部健康结果。
本综述通过理论行为改变的角度描述了促进糖尿病足自我管理的干预措施的证据。确定了一组与行为积极变化相关的核心行为改变活动和干预功能。这些信息将为研究人员开发自我管理干预措施提供有用的基础。
