Patients' Journey Toward Engagement in Self-Management of Diabetic Foot Ulcer in Adults With Types 1 and 2 Diabetes: A Constructivist Grounded Theory Study

Objectives: Our aim in this study was to develop the first theory that could explain the processes of engagement in self-management for adults with diabetic foot ulcer (DFU). Methods: A constructivist grounded theory, informed by Charmaz, and symbolic interactionism were used to guide the study design. Results: The findings from 30 study participants with active DFU draw attention to the complexity that exists for individuals seeking to balance life and manage their diabetes and DFU. The categories/phases and set of associated concepts comprise the theory known as The Journey Toward Engagement in Self-Management. This theory consists of 5 phases: 1) perception of illness, 2) noticing foot changes, 3) realizing seriousness, 4) beginning to learn about self-management and 5) engaging in self-management. The theory's phases describe the processes of engagement in self-management from participants' unique experience of living and managing DFU. Conclusions: The results show the pathways taken by participants to learn about self-management practices and how engagement in day-to-day management of DFU occurred. Engagement in self-management of an active DFU is complex and a developmental process that differs from participant to participant and changes over time. Although most participants preferred to take a more passive role in self-management of DFU (seen in phase 4), others demonstrated confidence to advance to another stage (seen in phase 5). At the advanced stage, they took an active role in self-management by expressing their needs and preferences, and were involved in their own care and decision-making related to treatment options. (C) 2020 Canadian Diabetes Association.