Patient and professional perspectives on prescribed therapeutic footwear for people with diabetes: a vignette study.

OBJECTIVE: This article draws on a qualitative study to identify and discuss patient and health professional views of the use of therapeutic footwear for people with diabetes-related foot complications.

METHODS: Semi-structured interviews were conducted with 15 patients and 15 health professionals using a 'vignette' technique. The interviews were audio-taped, and framework analysis was used to identify main themes and categories.

RESULTS: The prescription of therapeutic footwear was an important issue for patients, and health professionals were aware of this. The main issues were the differing perspectives between patients and professionals in terms of the expectations and reality of preventive behaviour, and difficulties in fitting shoes when feet are constantly changing shape.

CONCLUSIONS: Patients often have difficulty changing their shoe-wearing behaviour in line with guidelines, particularly within the limits of available therapeutic shoes. The choice of available shoes may not meet the varied and specific needs of patients. Patient perspectives therefore need to be taken into account in shoe provision.

PRACTICE IMPLICATIONS: The concept of concordance would appear to be useful in allowing patient needs to be identified before designing and prescribing therapeutic shoes. More choice in styles, and involving patients in footwear design and selection, might encourage the use of appropriate footwear.