Table 3

Key issues arising from our qualitative study and illustrative quotes

Issue arising from our qualitative studyParticipant quotes
Foot checking
 Some participants had physical limitations that make it difficult to check their feet.‘As you get older you’re not so mobile so you can’t see right underneath [your foot], so it’s a bit of guesswork until you do go…to [the] podiatrist’ (P10, Male)
 Some people found it difficult to know what to look for when foot checking and when to self-refer.‘Recognising them [DFUs] I think is the hardest part’ (P14, Male)
‘Sometimes…I go [to the podiatrist] and it’s not an ulcer…but I can’t tell’ (P8, Male)
 A few participants found it difficult to keep up foot checking long-term.‘You kind of become rather lax about perhaps doing it [foot checking] properly’ (P1, Male)
 There were mixed views on foot checking reminders.‘I don’t think I would need to be reminded. I’m doing it [foot checking] already, really’ (P3, Female)
‘It’s nice to have a reminder. Sometimes you get a bit complacent and you think “Oh, I’ll do it next time” ’ (P10, Male)
Rapid self-referral
 Some participants found it difficult to contact and get an appointment with their DFU team.‘Sometimes you can’t get appointments…By the time you are seeing somebody it’s either through [Accident and Emergency], because you’ve been rushed in ‘cause your foot’s swollen up and changed colour’ (P18, Female)
 Some participants expressed concerns about self-referring.‘If you do that [point out changes in foot health] every visit and it’s nothing to worry about, you’re paranoid, micromanaging. But if you don’t mention something you’ve seen previously, you’re complacent and don’t care about your health. You can’t win’ (P18, Female)
 Some participants found it difficult to know which health professional to contact when reporting DFUs.‘Who do you contact if you have a problem? Your own doctor? Or the nurse, diabetic nurse? Or the podiatrist?’ (P5, Male)
Physical activity
 Some participants have physical limitations that make it difficult to engage in physical activity.‘I get very breathless. I don’t walk much at all. I know I should, but I don’t’ (P3, Female)
 Some participants also expressed concerns about physical activity causing another DFU.‘Even though you might not have an ulcer, even if you go back to minimal activity…you can still get that ulcer come back’ (P18, Female)
 Some participants found it can be difficult to keep up with physical activity over time.‘It is easy to find something else to do [instead of physical activity]. You’ve got to be pretty disciplined’ (P6, Female)
 There were mixed views on pedometers.‘The pedometer is a really good idea though…It’s like a game—you want to make sure you can get as many steps in” (P20, Female)
‘[The pedometer is] almost like being spied on’ (P14, Male)
Emotional management
 Emotional management was relevant and valued by some participants, but not everyone.‘I’m one o’ these anxiety merchants, me. I worry for the world…so it’d [emotional management] be very helpful’ (P10, Male)
‘I don’t think personally I would have taken it [emotional management] on board at all…it’s not gonna make any difference to me…I just think I’ve got it [DFUs], I’ve got to put up with it…I don’t want to sit on a couch breathing in and out, I want to get on and do something’ (P2, Female)
Delivery methods
 Participants were positive about the idea of a website, but there were some concerns about computer literacy.‘Personally think the website would be far better than the booklet…It’s prodding me to do it [use the intervention]…If it’s in a leaflet, it just gets left ’ (P14, Male, internet user)
‘I love…anything interactive like that [the quiz in the example website] I think is great…you feel part of it [the intervention], rather than just being dictated to…[the information] tends to sink in better’ (P20, Female, internet user)
‘If I was competent…I would do it on the computer. But I’m not competent’ (P8, Male, infrequent internet user)
 A booklet might be helpful for quick reference and for those who do not use the internet.‘A booklet is always there, you can always refer to it, you’ve got something in black and white’ (P8, Male)
 Delivering the intervention via smartphone was less acceptable.‘Mobile phone—you’ve got all the problems of the computer, but on a smaller screen…a lot of diabetics [have] got problems with their eyes as well’ (P17, Male)
 Participants liked the idea of additional health professional support, but not for the intended purpose of supporting behaviour maintenance.‘It’d [additional health professional support] give me the confidence to know that ‘well, I am alright with my foot as it is’…because you can get a bit paranoid over it [your foot health]’ (P17, Male)
‘They could give…one-to-one advice on…is there anything else that you could do…better than what I’m doing myself’ (P3, Female)
  • DFU, diabetic foot ulcer.