title: Meeting the educational needs of people at risk of diabetes-related amputation: a vignette study with patients and professionals.
abstract: OBJECTIVE
  To investigate how patients and professionals view the role of advice in diabetes foot care, in order to inform educational practice.
  
  
  METHODS
  A qualitative study based upon one-to-one interviews using a vignette technique with patients and professionals.
  
  
  METHODS
  Interviews with 15 patients with diabetes-related foot complications attending diabetes foot clinics, and 15 health professionals across two hospital sites and two primary care trusts.
  
  
  RESULTS
  There were similarities between issues raised by patients and professionals, with differences in emphasis. An important factor was patient understanding and acceptance of the implications of diabetes from diagnosis. Many patients reported a lack of early understanding that may reflect inadequate provision or acceptance of advice. Development of positive relationships with health professionals was important for patients and encouraged shared understanding. Use of the vignette technique highlighted the gap between patient knowledge and action, with patients and professionals emphasizing their own responsibilities in relation to reduction of risk through education and action. Responses suggest that early positive interactions with appropriately trained professionals are needed to help patients assimilate advice into everyday routines.
  
  
  CONCLUSIONS
  For effective preventive care, patients need to understand how diabetes impacts on their health. Foot care education should begin early, be patient-centred and delivered with empathy by professionals whom the patients trust. The findings reflect patient and professional expectations in educational practice, and therefore have relevance for other chronic conditions for which much education and advice is related to self-care.
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, UK. m.johnson@sheffield.ac.uk
authors.forename: Maxine
authors.initials: M
authors.lastname: Johnson
authors.forename: Peggy
authors.initials: P
authors.lastname: Newton
authors.forename: Moyez
authors.initials: M
authors.lastname: Jiwa
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Goyder
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D048909:Diabetes Complications; D004739:England; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010353:Patient Education as Topic / Q000458:organization & administration*; D036301:Qualitative Research; D040242:Risk Reduction Behavior