• 1

    Perrin BM, Swerissen H, Payne C: The association between foot-care self efficacy beliefs and actual foot-care behaviour in people with peripheral neuropathy: a cross-sectional study. .J Foot Ankle Res 2::3. ,2009. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Valk GD, Kriegsman DM, Assendelft WJ: Patient education for preventing diabetic foot ulceration. .Cochrane Database Syst Rev 1::CD001488. ,2005. .

  • 3

    Singh N, Armstrong DG, Lipsky BA: Preventing foot ulcers in patients with diabetes. .JAMA 293::217. ,2005. .

  • 4

    Radford K, Chipchase S, Jeffcoate W: Education in the Management of the Foot in Diabetes, John Wiley & Sons, Chichester, England. ,2006. .

    • Crossref
    • PubMed
    • Export Citation
  • 5

    Greenfield S, Kaplan SH, Ware JE, et al: Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. .J Gen Intern Med 3::448. ,1988. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Kaplan SH, Greenfield S, Ware JE: Assessing the effects of physician-patient interactions on the outcomes of chronic disease. .Med Care 27::S110. ,1989. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Roter D: The enduring and evolving nature of the patient-physician relationship. .Patient Educ Couns 39::5. ,2000. .

  • 8

    Funnell MM, Anderson RM: MSJAMA: the problem with compliance in diabetes. .JAMA 284::1709. ,2000. .

  • 9

    Vileikyte L, Gonzalez JS, Leventhal H, et al: Patient Interpretation of Neuropathy (PIN) questionnaire: an instrument for assessment of cognitive and emotional factors associated with foot self-care. .Diabetes Care 29::2617. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Lincoln NB, Jeffcoate W, Ince P, et al: Validation of a new measure of protective footcare behavior: the Nottingham Assessment of Functional Footcare (NAFF). .Pract Diab Int 24::207. ,2007. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Pecoraro RE, Reiber GE, Burgess EM: Pathways to diabetic limb amputation: basis for prevention. .Diabetes Care 13::513. ,1990. .

  • 12

    Stockl K, Vanderplas A, Tafesse E, et al: Costs of lower-extremity ulcers among patients with diabetes. .Diabetes Care 27::2129. ,2004. .

  • 13

    Gordois A, Scuffham P, Shearer A, et al: The health care costs of diabetic peripheral neuropathy in the US. .Diabetes Care 26::1790. ,2003. .

  • 14

    Boulton AJ, Armstrong DG, Albert SF, et al: Comprehensive foot examination and risk assessment: a report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. .Phys Ther 88::1436. ,2008. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Centers for Disease Control: Age-adjusted hospital discharge rates for nontraumatic lower extremity amputation per 1,000 diabetic population, by race, United States, 1980–2005. Available at: http://www.cdc.gov/diabetes/statistics/lea/fig6.htm. Accessed December. 2009. .

    • PubMed
    • Export Citation
  • 16

    Armstrong DG, Wrobel J, Robbins JM: Are diabetes related wounds and amputations worse than cancer. .Int Wound J 4::286. ,2007. .

  • 17

    Knight KM, Dornan T, Bundy C: The diabetes educator: trying hard, but must concentrate more on behaviour. .Diabet Med 23::485. ,2006. .

  • 18

    Robbins JM, Strauss G, Aron D, et al: Mortality rates and diabetic foot ulcers: is it time to communicate mortality risk to patients with diabetic foot ulceration?. JAPMA 98::489. ,2008. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Barth R, Campbell LV, Allen S, et al: Intensive education improves knowledge, compliance, and foot problems in type 2 diabetes. .Diabet Med 8::111. ,1991. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Ronnemaa T, Hamalainen H, Toikka T, et al: Evaluation of the impact of podiatrist care in the primary prevention of foot problems in diabetic subjects. .Diabetes Care 20::1833. ,1997. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Hamalainen H, Ronnemaa T, Toikka T, et al: Long-term effects of one year of intensified podiatric activities on foot-care knowledge and self-care habits in patients with diabetes. .Diabetes Educ 24::734. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Rollnick S, Mason P, Butler C: Health Behavior Change: A Guide for Practitioners, Churchill Livingstone, London. ,2000. .

    • PubMed
    • Export Citation
  • 23

    Miller WR, Rollnick S: Motivational Interviewing: Preparing People for Change, Guilford Press, New York. ,2002. .

    • PubMed
    • Export Citation
  • 24

    Britt E, Hudson SM, Blampied NM: Motivational interviewing in health settings: a review. .Patient Educ Couns 53::147. ,2004. .

  • 25

    Rubak S, Sandbaek A, Lauritzen T, et al: Motivational interviewing: a systematic review and meta-analysis. .Br J Gen Pract 55::305. ,2005. .

  • 26

    Rollnick S, Miller WR, Butler CC: Motivational Interviewing in Health Care: Helping Patients Change Behavior, Guilford Press, New York. ,2008. .

    • Crossref
    • PubMed
    • Export Citation
  • 27

    Hettema J, Steele J, Miller WR. A: Meta-analysis of Research on Motivational Interviewing Treatment Effectiveness (MARMITE). 2004. Available at: http://www.motivationalinterview.org/library/MARMITE_files/frame.htm. Accessed December 9. ,2010. .

    • PubMed
    • Export Citation
  • 28

    Emmons KM, Rollnick S: Motivational interviewing in health care settings: opportunities and limitations. .Am J Prev Med 20::68. ,2001. .

  • 29

    Williams GC, McGregor H, Zeldman A, et al: Promoting glycemic control through diabetes self-management: evaluating a patient activation intervention. .Patient Educ Couns 56::28. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Williams GC, Freedman ZR, Deci EL: Supporting autonomy to motivate patients with diabetes for glucose control. .Diabetes Care 21::1644. ,1998. .

  • 31

    Williams GC, Grow VM, Freedman ZR, et al: Motivational predictors of weight loss and weight-loss maintenance. .J Pers Soc Psychol 70::115. ,1996. .

  • 32

    Williams GC, McGregor HA, Sharp D, et al: Testing a self-determination theory intervention for motivating tobacco cessation: supporting autonomy and competence in a clinical trial. .Health Psychol 25::91. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Williams GC, Rodin GC, Ryan RM, et al: Autonomous regulation and long-term medication adherence in adult outpatients. .Health Psychol 17::269. ,1998. .

  • 34

    Hettema J, Steele J, Miller WR: Motivational interviewing. .Annu Rev Clin Psychol 1::91. ,2005. .

  • 35

    Burke BL, Arkowitz H, Menchola M: The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. .J Consult Clin Psychol 71::843. ,2003. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Ellis SE, Speroff T, Dittus RS, et al: Diabetes patient education: a meta-analysis and meta-regression. .Patient Educ Couns 52::97. ,2004. .

  • 37

    Dunn C, Deroo L, Rivara FP: The use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review. .Addiction 96::1725. ,2001. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Vasilaki EI, Hosier SG, Cox WM: The efficacy of motivational interviewing as a brief intervention for excessive drinking: a meta-analytic review. .Alcohol 41::328. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Channon SJ, Huws-Thomas MV, Rollnick S, et al: A multicenter randomized controlled trial of motivational interviewing in teenagers with diabetes. .Diabetes Care 30::1390. ,2007. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    West DS, DiLillo V, Bursac Z, et al: Motivational interviewing improves weight loss in women with type 2 diabetes. .Diabetes Care 30::1081. ,2007. .

  • 41

    Smith DE, Heckemeyer CM, Kratt PP, et al: Motivational interviewing to improve adherence to a behavioral weight-control program for older obese women with NIDDM: a pilot study. .Diabetes Care 20::52. ,1997. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Stuckey HL, Dellasega C, Graber NJ, et al: Diabetes nurse case management and motivational interviewing for change (DYNAMIC): study design and baseline characteristics in the Chronic Care Model for type 2 diabetes. .Contemp Clin Trials 30::366. ,2009. .

    • PubMed
    • Search Google Scholar
    • Export Citation

Motivational Interviewing by Podiatric Physicians

A Method for Improving Patient Self-care of the Diabetic Foot

Robert A. Gabbay Penn State Institute for Diabetes and Obesity, Division of Endocrinology, Diabetes, and Metabolism, Penn State College of Medicine, Hershey, PA.

Search for other papers by Robert A. Gabbay in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Shailja Kaul Penn State Institute for Diabetes and Obesity, Division of Endocrinology, Diabetes, and Metabolism, Penn State College of Medicine, Hershey, PA.

Search for other papers by Shailja Kaul in
Current site
Google Scholar
PubMed
Close
 MD
,
Jan Ulbrecht Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA.

Search for other papers by Jan Ulbrecht in
Current site
Google Scholar
PubMed
Close
 MBBS
,
Neil M. Scheffler Baltimore Podiatry Group, Baltimore, MD.

Search for other papers by Neil M. Scheffler in
Current site
Google Scholar
PubMed
Close
 DPM
, and
David G. Armstrong Department of Surgery, University of Arizona College of Medicine, Tucson, AZ.

Search for other papers by David G. Armstrong in
Current site
Google Scholar
PubMed
Close
 DPM, MD, PhD

Foot ulceration and lower-extremity amputation are devastating end-stage complications of diabetes. Despite agreement that diabetic foot self-care is a key factor in prevention of ulcers and amputation, there has only been limited success in influencing these behaviors among patients with diabetes. While most efforts have focused on increasing patient knowledge, knowledge and behavior are poorly correlated. Knowledge is necessary but rarely sufficient for behavior change. A key determinant to adherence to self-care behavior is clinician counseling style. Podiatrists are the ideal providers to engage in a brief behavioral intervention with a patient. Motivational interviewing is a well-accepted, evidence-based teachable approach that enhances self-efficacy and increases intrinsic motivation for change and adherence to treatment. This article summarizes some key strategies that can be employed by podiatrists to improve foot self-care. (J Am Podiatr Med Assoc 101(1): 78–84, 2011)

Corresponding author: Robert A. Gabbay, MD, PhD, Penn State Institute for Diabetes and Obesity, Penn State College of Medicine, 500 University Dr, H044, Room C-6630, Hershey, PA 17033. (E-mail: rgabbay@hmc.psu.edu)
Save