Intervention planning for the REDUCE maintenance intervention: a digital intervention to reduce re-ulceration risk among patients with a history of diabetic foot ulcers

Greenwell, Kate, Sivyer, Katy, Vedhara, Kavita, Yardley, Lucy, Game, Frances, Chalder, Trudie, Richards, Gayle, Drake, Nikki, Gray, Katie, Weinman, John and Bradbury, Katherine (2018) Intervention planning for the REDUCE maintenance intervention: a digital intervention to reduce re-ulceration risk among patients with a history of diabetic foot ulcers. BMJ Open, 8 (5). pp. 1-12. ISSN 2044-6055

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Objectives: To develop a comprehensive intervention plan for the REDUCE maintenance intervention to support people who have had diabetic foot ulcers (DFUs) to sustain behaviours that reduce re-ulceration risk.

Methods: Theory-, evidence- and person-based approaches to intervention development were used. In phase 1 of intervention planning, evidence was collated from a scoping review of the literature and qualitative interviews with patients who have had DFUs (N=20). This was used to identify the psychosocial needs and challenges of this population, and barriers and facilitators to the intervention’s target behaviours: regular foot checking, rapid self-referral in the event of changes in foot health, graded and regular physical activity, and emotional management. In phase 2, this evidence was combined with expert consultation to develop the intervention plan. Brief ‘guiding principles’ for shaping intervention development were created. ‘Behavioural analysis’ and ‘logic modelling’ were used to map intervention content onto behaviour change theory to comprehensively describe the intervention and its hypothesised mechanisms.

Results: Key challenges to the interventions’ target behaviours included patients’ uncertainty regarding when to self-refer, physical limitations affecting foot checking and physical activity, and, for some, difficulties managing negative emotions. Important considerations for the intervention design included a need to increase patients’ confidence in making a self-referral and in using the maintenance intervention, and a need to acknowledge that some intervention content might be relevant to only some patients (emotional management, physical activity). The behavioural analysis identified the following processes hypothesised to facilitate long-term behaviour maintenance including; increasing patients’ skills, self-efficacy, knowledge, positive outcome expectancies, sense of personal control, social support, and physical opportunity.

Conclusions: This research provides a transparent description of the intervention planning for the REDUCE maintenance intervention. It provides insights into potential barriers and facilitators to the target behaviours and potentially useful behaviour change techniques to use in clinical practice.

Item Type: Article
Keywords: Diabetic foot ulcers; Digital Intervention; Re-ulceration Risk
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Primary Care
Identification Number:
Depositing User: McCambridge, Mrs April
Date Deposited: 19 Apr 2018 10:46
Last Modified: 25 May 2018 04:07

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