Diabetes distress and health literacy in diabetic foot disease

Background

Health literacy refers to the combination of personal competencies and situational resources needed for people to access, understand, appraise, and use information and services to make decisions about their health and self-care. Low health literacy limits access to (self-)care and may increase the risk of amputation and/or recidivist foot ulcers. Organizational literacy may be of crucial significance for the prevention of diabetic foot ulcers to people at risk. This refers to the way in which services, organisations, and resources are made available and accessible to people according to their individual health literacy level.
Diabetes distress is the emotional reaction to living with diabetes which can take the many forms including difficulty in self-care of diabetes. Moderate to high levels of diabetes distress are likely to have a negative influence on outcomes of diabetic foot disease and may play a considerable role in the prevention of foot ulcers and amputation; however, knowledge about diabetes distress levels among people with or at high risk of diabetic foot ulcers is very limited – if existing.
This project focuses on diabetes distress and health literacy among people with or at risk of foot ulceration, two key factors that may affect the ability to prevent diabetic foot disease and amputations. DC2 explores the role of these psychosocial factors in diabetic foot disease and investigates how they can be effectively addressed within routine diabetes foot care to improve prevention efforts.

Approach

The DC2 project investigates the complex and understudied relationships between diabetes distress, health literacy, and diabetic foot disease. Specifically, the project will 1) map existing research on psychosocial aspects of diabetic foot disease through a systematic scoping review of 114 studies, 2) assess levels of diabetes distress and health literacy among people with or at risk of diabetic foot disease, 3) examine the quantitative associations between diabetes distress, health literacy, and diabetic foot disease, 4) explore the perceived psychosocial needs in diabetic foot care, from the perspectives of both people with or at risk of diabetic foot disease, and their healthcare providers.
The project draws on robust quantitative data sources, including clinical records from Steno Diabetes Center Copenhagen, new self-reported data, and data from approximately 2000 participants from The Maastricht Study, a large prospective Dutch cohort. Qualitative data will be collected across multiple European countries to enrich the findings. Throughout the project, the doctoral candidate employs a mixed-methods approach to deepen understanding of how diabetes distress and health literacy interact with diabetic foot disease. Insights gained will guide the development of strategies to support the psychosocial wellbeing of people with or at risk of diabetic foot disease. These strategies may include reducing diabetes distress, enhancing organizational health literacy responsiveness, and fostering equitable communication between patients and healthcare providers – specifically tailored to the context of diabetic foot care.

Our research team

Steno Diabetes Center Copenhagen (SDCC) is a diabetes center within the public authority of the Capital Region of Copenhagen. SDCC is the largest diabetes clinic in Scandinavia and treats each year more than 11,000 people with diabetes from the Capital Region. SDCC is organised in four departments (Patient Care, Clinical Research, Health Promotion Research, and Education) that work closely together around the unifying focus of translational research, diabetes care, and prevention. The doctoral candidate will be part of the Psychosocial health in Life with Chronic illness Research group which is embedded within the Prevention, Health Promotion and Community care Department. The candidate will learn from and collaborate with a multidisciplinary team of clinicians and researchers. The doctoral candidate will also work together with another doctoral candidate from DIALECT at SDCC who, in an epidemiologic study, focuses on ulcer risk stratification in high-risk people with diabetes.

Secondments for this project include Amsterdam University Medical Centers (AMC, Amsterdam, the Netherlands) and Maastricht University (UM, Maastricht, the Netherlands). Amsterdam UMC is a leading institute in the world on biomechanical and clinical research on diabetic foot disease, in particular on the prevention of foot ulceration and amputationThe Maastricht University facilitates access on The Maastricht Study data, a large observational prospective population-based cohort study, and provides DC2 training on advanced quantitative analyses.

Steno Diabetes Center Copenhagen

Steno Diabetes Center Copenhagen (SDCC) is a diabetes center within the public authority of the Capital Region of Copenhagen. SDCC is the largest diabetes clinic in Scandinavia and treats each year more than 11,000 people with diabetes from the Capital Region.