Experiences and guidelines for footcare practices of patients with diabetes mellitus

The former Transkei is a predominantly rural region of the Eastern Cape Province. The poor infrastructure in this area results in inaccessibility of the available health services. The majority is ill equipped to deliver optimum diabetes care. There is an increase of lower limb amputations and lack of knowledge among patients with diabetes mellitus in the former Transkei. These complications can be prevented by patient education on self-management and appropriate footcare procedures. This qualitative study was conducted to explore and describe the experiences and footcare practices of diabetic patients who live in the rural areas of Transkei. A sample of 15 participants was drawn from Umtata Hospital Diabetic Clinic register through predetermined selection criteria. The sample consisted of five men aged 49-74 years, and ten women aged 30-64 years. Five patients (two men and three women) had foot ulcers or an amputation, while ten patients had no obvious foot problems. Indepth phenomenological interviews were conducted with all 15 patients. Interviews were tape recorded in Xhosa, transcribed, and translated into English for analysis. Direct observation of footcare was done with eight patients from the sample. Content analysis of the phenomenological interviews was facilitated by a protocol; and a checklist guided direct observation of footcare. A debate took place among the three coders to come to a consensus about the themes that emerged from their individual analyses. Guba's model of trustworthiness was utilised to ensure that the findings of this study reflect the truth. Ethical considerations were based on the guidelines cited by the Democratic Nursing Organisation of South Africa (1998: 2.3.1-2.3.4) and the South African Medical Research Council (1993: 32-44). Findings revealed predominantly negative experiences in the internal and external environments of the persons with diabetes mellitus; as well as poor footcare knowledge and practices. The recommendations relate to improving diabetes mellitus as well as their footcare knowledge and skills through education; promoting adherence to treatment regimens; providing emotional support; improving their self-image; changing health beliefs; improving the quality of care in public health facilities; and increasing awareness among employers of persons with diabetes mellitus.