Barriers to Self-Management of Patients with Diabetic Foot Ulcers: A Systematic Review and Qualitative Meta-Synthesis

To synthesize qualitative research on self-management among patients with diabetic foot ulcers (DFUs) to provide insights and recommendations for enhancing self-management interventions.

A comprehensive search of PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, WanFang, and VIP databases was conducted through August 15, 2024.

Studies were selected based on the PICo-D model; P (Population) was patients with DFUs, I (Interest) was barriers to self-management, Co (Context) was the patient's life following a DFU diagnosis, and D (Design) was qualitative or mixed-method studies. Exclusion criteria included duplicate publications, unavailable full text, and literature published in languages other than Chinese or English.

Two researchers independently screened, assessed quality, and extracted data. Discrepancies were resolved by discussion or a third reviewer. Extracted data included authors, year, country, methodology, sample size, phenomenon of interest, and key findings.

A meta-synthesis approach integrated findings from 14 studies with 256 participants. Barriers to DFU self-management were grouped into eight themes: (a) cognitive factors (eg, lack of knowledge, information processing, decision-making abilities, self-efficacy); (b) emotional factors; (c) behavioral factors (eg, behavioral habits, adherence); (d) social factors (eg, social resources, social support); (e) economic factors; (f) environmental factors (eg, living environment, environmental support); (g) policy factors (eg, policy support, resource allocation, regulatory restrictions); and (h) cultural factors (eg, cultural identity, traditional beliefs).

Patients with DFUs face multiple barriers to effective self-management. Health care providers should focus on enhancing health education, providing psychological support, fostering a supportive environment, and implementing personalized interventions to improve patients' self-management abilities and strengthen their overall prognosis.