Abstract
OBJECTIVE: To investigate how patients and professionals view the role of advice in diabetes foot care, in order to inform educational practice. DESIGN: A qualitative study based upon one-to-one interviews using a vignette technique with patients and professionals. SETTING AND PARTICIPANTS: Interviews with 15 patients with diabetes-related foot complications attending diabetes foot clinics, and 15 health professionals across two hospital sites and two primary care trusts. RESULTS: There were similarities between issues raised by patients and professionals, with differences in emphasis. An important factor was patient understanding and acceptance of the implications of diabetes from diagnosis. Many patients reported a lack of early understanding that may reflect inadequate provision or acceptance of advice. Development of positive relationships with health professionals was important for patients and encouraged shared understanding. Use of the vignette technique highlighted the gap between patient knowledge and action, with patients and professionals emphasizing their own responsibilities in relation to reduction of risk through education and action. Responses suggest that early positive interactions with appropriately trained professionals are needed to help patients assimilate advice into everyday routines. CONCLUSIONS: For effective preventive care, patients need to understand how diabetes impacts on their health. Foot care education should begin early, be patient-centred and delivered with empathy by professionals whom the patients trust. The findings reflect patient and professional expectations in educational practice, and therefore have relevance for other chronic conditions for which much education and advice is related to self-care.