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Development of a Motivation Communication Training to Aid Diabetes-Specialist Podiatrists With Adherence Discussions

Hancox, Jennie; Chaplin, Wendy; Hilton, Charlotte; Gray, Katie; Game, Fran; Vedhara, Kavita

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Jennie Hancox

Charlotte Hilton

Katie Gray

Fran Game

Kavita Vedhara


Diabetic foot ulcers (DFUs) impact a substantial proportion of patients with diabetes, with high recurrence rates, severe complications, and significant financial burden to health care systems. Adherence to treatment advice (e.g., limiting weight-bearing activity) is low with patients reporting dissatisfaction with the way in which advice is communicated. This study aimed to address this problem via the systematic development of a motivation communication training program. The program was designed to support diabetes-specialist podiatrists in empowering patients to actively engage with treatment. The development process followed an intervention mapping approach. Needs assessment involved observations of 24 patient–practitioner consultations within a diabetes-specialist foot clinic. This informed specification of a theory of change (self-determination theory) and relevant evidence-based communication strategies (drawing from motivational interviewing). The training program was developed iteratively with changes made following feedback from five diabetic foot health care professionals. The resulting training program, consisting of six one-hour face-to-face sessions over an 8-week period, was delivered to a further six diabetes specialist podiatrists, with five participating in postprogram telephone interviews to assess acceptability. Deductive thematic analysis of interview data revealed positive aspects of the training (e.g., valuable and relevant content), ideas for improvement (e.g., online resources and context-specific video examples), the acceptability of motivation strategies, and challenges putting the strategies into practice (such as time constraints and breaking old communication habits). This study contributes to our understanding of integrating motivation principles into routine consultations and holds potential for enhancing adherence to treatment recommendations in patients living with diabetic foot ulcers.

Journal Article Type Article
Acceptance Date Dec 1, 2023
Online Publication Date Dec 14, 2023
Publication Date Dec 14, 2023
Deposit Date Mar 1, 2024
Publicly Available Date Mar 4, 2024
Journal Health Education and Behavior
Print ISSN 1090-1981
Electronic ISSN 1552-6127
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 51
Issue 2
Pages 240 -250
Public URL
Publisher URL


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