Effectiveness of a foot self-management intervention that utilized commercially available infrared thermometers: a patient-oriented research and mixed methods research study

Stevens, Laura Kathleen (2020) Effectiveness of a foot self-management intervention that utilized commercially available infrared thermometers: a patient-oriented research and mixed methods research study. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Background: Patients with diabetes are at high risk for foot issues such as diabetic foot ulcers (DFUs). Given the prevalence, health care costs, and implications of DFUs, it is vital to support effective foot self-management. Education and a commercially available infrared thermometer (CAIT) are promising strategies. As foot self-management is complex, research that develops and tests interventions needs to be patient-oriented to ensure contextual issues are addressed. Methods: A sequential mixed methods research (MMR) study with 3 phases was conducted with an exploratory and explanatory sequence. Phase 1 to the development of the Phase 2 intervention comprised the exploratory sequence (N=24): qualitative interviews were completed with 11 patients, 9 health care providers, and 4 support persons to explore foot self-management. Phase 2 and 3 comprised the explanatory sequence. Phase 2: a randomized control trial (RCT) pilot that tested the intervention was conducted (thermometer and education group, n=34; and an education-only group, n=26). Phase 3: interviews were conducted with RCT participants to gain understanding of the Phase 2 findings (N =9). Results: Phase 1 findings showed that people experienced personal challenges, encountered system barriers, and utilized resources to support foot self-management (presented in Manuscript 1). These findings helped inform the intervention. The RCT found that the thermometer and education group had significantly more days with any assessment completed than the education only group (150.98/180 vs. 119.84/180, p =.02). The study had low power to assess the outcome of DFU. Phase 3 findings offered further explanation that the CAIT engaged participants, prompted action, and offered reassurance about foot health. Phases 2 and 3 are presented in Manuscript 2. This research approach resulted in the testing of a patient-oriented intervention and provided a greater understanding of intervention effectiveness. The benefit and synergy achieved when using this approach is presented in Manuscript 3. iii Conclusion: The CAIT is an available tool that could support effective foot self-management for people with diabetes. This tool may offer several benefits such as promoting and providing structure for a foot assessment and direction for action.

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