An explorative study on the efficacy and feasibility of the use of motivational interviewing to improve footwear adherence in persons with diabetes at high risk for foot ulceration

Abstract

Background: In this explorative study, we assessed the effect and feasibility of using motivational interviewing to improve footwear adherence in persons with diabetes who are at high risk for foot ulceration and show low adherence to wearing prescribed custom-made footwear. Methods: Thirteen individuals with diabetes, ulcer history, and low footwear adherence (ie,,80% of steps taken in prescription footwear) were randomly assigned to standard education (ie, verbal and written instructions) or to standard education plus two 45-min sessions of motivational interviewing. Adherence was objectively measured over 7 days using ankle-and shoe-worn sensors and was calculated as the percentage of total steps that prescribed footwear was worn. Adherence was assessed at home and away from home at baseline and 1 week and 3 months after the intervention. Feasibility was assessed for interviewer proficiency to apply motivational interviewing and for protocol executability. Results: Medi an (range) baseli ne, 1-week, and 3-month adherence at home was 49% (6%–63%), 84% (5%–98%), and 40% (4%–80%), respectively, i n the moti vati onal i nterviewi ng group and 35% (13%–64%), 33% (15%–55%), and 31% (3%–66%), respecti vel y, i n the standard educati on group. Basel i ne, 1-week, and 3-month adherence away from home was 91% (79%–100%), 97% (62%–99%) and 92% (86%–98%), respecti vely, in the motivational interviewing group and 78% (32%–97%), 91% (28%–98%), and 93% (57%–100%), respecti vel y, in the standard educati on group. None of the di fferences were statistical ly si gni ficant. Intervi ewer profici ency was good, and the protocol coul d be successful ly executed in the given time frame. Conclusions: Footwear adherence at home increases 1 week after moti vati onal i nterviewi ng to cli ni call y rel evant but not stati sti call y si gni ficant l evel s (ie, 80%) but then returns over time to baseli ne l evel s. Away from home, adherence i s al ready sufficient at basel ine and remai ns so over ti me. The use of moti vati onal interviewi ng seems feasible for the gi ven purpose and pati ent group. These findings provide input to larger tri al s and provi sional ly suggest that addi ti onal or adjunctive therapy may be needed to better preserve adherence.