Care Management Challenges for Diabetic Foot Ulcers: A Qualitative Study

Background: Diabetes mellitus, if is not well taken care and treated, may exacerbate complications such as ulcers, infections, and amputations. Accordingly, preventive measures and timely treatment are of paramount importance. Objectives: This study sought to collect profound experiences about diabetic ulcer care management with an emphasis on community-based care. Methods: The study was carried out using the qualitative content analysis method during 2017 - 2018 in Semnan Province, Iran. The study encompassed 14 participants, including six caregivers, two family members, one nurse, one nursing supervisor, one manager of counseling and nursing care service centers (CNCSCs), one head nurse, and two physicians, who were selected using the purposive sampling method. The analysis process was performed based on Graneheim and Lundma’s approach. Results: Two main categories were as follows: (1) "Dispersion in preventive measures," with subcategories of ‘vague perception of disease symptoms’, ‘inability in self-management’ and ‘low-efficient preventive care’, and (2) "Gradual access to outpatient services" with subcategories of ‘gradual expansion of outpatient ulcer care’, ‘complexity of financial transactions’, ‘improving inter-sectoral cooperation’ and ‘ambiguous professional boundaries’. Conclusions: Care facilities offering services to diabetic foot ulcers, especially community-based nursing care centers, are grad- ually expanding, and new wound care methods are being adopted. However, lack of self-care management, insufficient support, treatment-oriented approaches, and all clients’ insufficient access to these services are some of the problems that still exist in the care management of diabetic ulcers.