First step in tackling foot ulcers and amputation in areas of multiple deprivation in Scotland
Podiatry researchers at Glasgow Caledonian University have been awarded £299,751 to tackle diabetes-related foot ulceration, particularly in areas of multiple deprivation in Scotland, using a new approach based on motivational interviewing.
Drs Ruth Barn, Gordon Hendry and Jodi Binning have secured the grant from the Scottish Government’s Chief Scientist Office (CSO) to carry out their research project entitled Motivational Interviewing For The Prevention Of Diabetes-Related Foot Ulceration In People Exposed To Multiple Deprivation: A Pilot Trial.
The expert team hope that the new treatment, based on motivational interviewing, will empower patients to adopt new lifestyle changes and ultimately reduce ulceration, amputation and death rates among people with diabetes.
Foot ulcers are wounds that appear below the ankle that can lead to serious complications including amputation and death. They affect between 19-34% of people with diabetes and are more common in areas of multiple deprivation.
Research already carried out in the Greater Glasgow and Clyde health board area, led by the team at Glasgow Caledonian University, using a special mapping technique, found that those with diabetes living in the most deprived areas were four to five times more likely to experience a foot ulcer, amputation or death than those living in the least deprived areas.
Dr Barn explained: “Current treatment approaches are not effective. People with diabetes are well informed about their condition but this does not necessarily lead to behaviour change.
“We have developed a new treatment based on motivational interviewing − a way of having a conversation with a person that helps them understand their reasons and barriers to positive lifestyle change, and supports adoption of new behaviours, or stopping unhelpful behaviours, to prevent foot ulcers. This approach has previously been successful for people attending services in other areas such as addictions, long-term condition management and weight loss.
“Our aim is to undertake a small trial, comparing motivational interviewing to current care, to find out if a larger trial is possible and worth doing. We hope that this intervention could empower people with diabetes and foot ulceration, leading to improved self-care, and reduced ulceration and amputation rates, in the long run.”
The three-year pilot trial is a collaboration with NHS Greater Glasgow and Clyde, Tayside, Ayrshire and Arran and Lanarkshire. The researchers will be training podiatrists on how to deliver motivational interviewing, specifically for people with diabetes who are at greatest risk of developing complications related to their condition.
Dr Binning, who is also Podiatry Service Manager for NHS Ayrshire & Arran, carried out research as part of her PhD which showed that motivational interviewing was effective and had encouraging results from patients from areas of multiple deprivation in Glasgow.
“People involved in the study said that the approach is more individualised and feels different. Of the 17 people who took part, 15 reported positive behaviour changes,” said Dr Binning.
Dr Hendry added: “While motivational interviewing intervention is focused on behaviour change, the actual outcome we are interested in reducing is the number of ulcers that people develop during that follow up period. As little as a 10% reduction in ulceration rate could bring significant cost-benefits to the NHS and would be enough to justify a much larger future trial.
“It’s possible that a little bit of behaviour change chosen and driven by patients themselves, with the support of highly trained podiatrists, will have a tangible effect on reducing ulceration and amputation rates in a group that has greater need.”
The researchers are based in the School of Health and Life Sciences’ Research Centre for Health (ReaCH) and are members of the Musculoskeletal Health Research Group.
Photo (left to right) Drs Jodi Binning, Ruth Barn and Gordon Hendry.