Care away from the clinic – beliefs of self-care in a multicultural society

The majority of care for a patient with a diabetic foot ulcer takes place away from the clinic, in the patient’s own environment. However, it is not easy for clinicians to assess what happens there. It may vary from patient to patient, depending on a large variety of circumstances. One of them concerns a person’s background. In Australia’s multicultural society, these backgrounds can greatly differ. And this may impact someone’s belief of their self-care needed for their feet.

New Swedish research has looked at beliefs of self-care in foreign-born people from a European or Middle Eastern background. As these are two relevant groups of immigrants for Australia as well, it is worth to have a look at this paper.

A qualitative research approach was chosen, which is the best methodology for such a complicated and personal topic. This also underlines that large multicentre cohort studies are not the only methodology to be used to advance our diabetic foot care. The researchers undertook semi-structured interviews with 26 patients with (a history of) diabetic foot ulcers. A relatively large group for a qualitative study, but a weakness is the poor description of the foot ulcer (history) of the participants.

Participants told the researchers that they felt ulcers were unavoidable and difficult to detect, and they described limited self-care. These are important findings, as research continues to show that ulcers are preventable and self-care is much needed. Patients also indicated they had received advice. People from the Middle-East differed from European immigrants with regard to the importance of their religion, with their belief in Allah leading to even poorer quality of life and more negative view of health.

What this study means for your clinical practice is that it stresses the continuing importance to communicate with your patients. It is imperative to understand your patients’ health beliefs against different cultural backgrounds, and to make sure that any advice given on self-care is also understood and put into practice.