title: Reducing the burden of chronic wounds: prevention and management of the diabetic foot in the context of clinical guidelines.
abstract: OBJECTIVE
  Chronic wounds such as diabetic foot and venous leg ulcers are a major burden for health services. Our programme was developed to explore the psychological and behavioural factors that may influence both the incidence of chronic wounds and their progression. The present article focuses on two particular aspects of the programme: patient knowledge of diabetic foot ulceration and factors influencing foot-related behaviour in patients with and without foot ulcers; and patient and podiatrist perspectives of consultations for diabetic foot ulcers.
  
  
  METHODS
  Two independent qualitative studies were undertaken: one with diabetic patients without a history of ulceration; and the other with diabetic patients with active ulceration and podiatrists treating these patients.
  
  
  RESULTS
  We found that patients may find it difficult understanding the rationale underlying prevention and treatment of foot ulcers; ulcerated patients may find it difficult to engage in the management of their foot ulcer outside consultations; and some podiatrists feel frustrated and unsupported in their attempts at empowering and building partnerships with patients.
  
  
  CONCLUSIONS
  Patient and practitioner factors may contribute to the effective implementation of clinical guidelines regarding education, partnership building and shared decision-making. These findings are discussed in relation to patient education, partnership building and shared decision-making as recommended in NICE guidelines.
authors.affiliation: Department of Social Medicine, University of Bristol, Bristol, UK.
authors.forename: Aidan
authors.initials: A
authors.lastname: Searle
authors.forename: Lone
authors.initials: L
authors.lastname: Gale
authors.forename: Rona
authors.initials: R
authors.lastname: Campbell
authors.forename: Mark
authors.initials: M
authors.lastname: Wetherell
authors.forename: Karen
authors.initials: K
authors.lastname: Dawe
authors.forename: Nikki
authors.initials: N
authors.lastname: Drake
authors.forename: Colin
authors.initials: C
authors.lastname: Dayan
authors.forename: John
authors.initials: J
authors.lastname: Tarlton
authors.forename: Jeremy
authors.initials: J
authors.lastname: Miles
authors.forename: Kavita
authors.initials: K
authors.lastname: Vedhara
mesh_terms: D000368:Aged; D017281:Cost of Illness; D003657:Decision Making; D017719:Diabetic Foot / Q000517:prevention & control* / Q000628:therapy*; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010358:Patient Participation; D017410:Practice Guidelines as Topic; D012648:Self Care