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

OBJECTIVE: To synthesize qualitative research on self-management among patients with diabetic foot ulcers (DFUs) to provide insights and recommendations for enhancing self-management interventions. DATA SOURCES: A comprehensive search of PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, WanFang, and VIP databases was conducted through August 15, 2024. STUDY SELECTION: 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. DATA EXTRACTION: 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. DATA SYNTHESIS: 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). CONCLUSIONS: 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.