Article Text
Abstract
Objectives To develop a comprehensive intervention plan for the REDUCE maintenance intervention to support people who have had diabetic foot ulcers (DFUs) to sustain behaviours that reduce reulceration risk.
Methods Theory-based, evidence-based and person-based approaches to intervention development were used. In phase I of intervention planning, evidence was collated from a scoping review of the literature and qualitative interviews with patients who have had DFUs (n=20). This was used to identify the psychosocial needs and challenges of this population and barriers and facilitators to the intervention’s target behaviours: regular foot checking, rapid self-referral in the event of changes in foot health, graded and regular physical activity and emotional management. In phase II, this evidence was combined with expert consultation to develop the intervention plan. Brief ‘guiding principles’ for shaping intervention development were created. ‘Behavioural analysis’ and ‘logic modelling’ were used to map intervention content onto behaviour change theory to comprehensively describe the intervention and its hypothesised mechanisms.
Results Key challenges to the intervention’s target behaviours included patients’ uncertainty regarding when to self-refer, physical limitations affecting foot checking and physical activity and, for some, difficulties managing negative emotions. Important considerations for the intervention design included a need to increase patients’ confidence in making a self-referral and in using the maintenance intervention and a need to acknowledge that some intervention content might be relevant to only some patients (emotional management, physical activity). The behavioural analysis identified the following processes hypothesised to facilitate long-term behaviour maintenance including increasing patients’ skills, self-efficacy, knowledge, positive outcome expectancies, sense of personal control, social support and physical opportunity.
Conclusions This research provides a transparent description of the intervention planning for the REDUCE maintenance intervention. It provides insights into potential barriers and facilitators to the target behaviours and potentially useful behaviour change techniques to use in clinical practice.
- diabetic foot
- wound management
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Footnotes
KG and KS are joint first authors.
Contributors All authors designed the study. KGre, KS, KB and LY led the intervention planning, with input from the other coauthors. KGre and KS were responsible for recruitment, carrying out the interviews and analysing the data, with support from KB. KGre and KS jointly drafted the manuscript with initial support from KB and LY. All authors critically reviewed the manuscript, contributing important intellectual content and approved the final manuscript.
Funding This article summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Development Grants Programme (Grant Reference Number RP-DG-0615-10005) and the NIHR Biomedical Research Centre at South London and Maudsley NHS and Kings College London.
Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Competing interests KGre, KS, KV, LY, FG, TC, ND, GR and KB had financial support from NIHR for the submitted work; TC had other support from NIHR.
Patient consent Not required.
Ethics approval North West – Greater Manchester West Research Ethics Committee (17/NW/0024).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.