530-P: Self- and Family-Management Experiences of Barriers and Facilitators in the People Living with Diabetic Foot Ulcers and Comorbidity-A Qualitative Study

Objective: Diabetic foot ulcers are the leading cause of lower extremity amputations and require foot care for healing and prevention of recurrence, especially in family care settings. Patients' high prevalence of co-morbidity is directly to risks of adverse outcomes including poor functional status and low quality of life, which needs self- and family management (SFM) beyond foot care for better prognosis. This qualitative study aimed to identify factors that impact patients and their families to manage patients' health and meet health-related goals after discharge. Methods: Semi-structured in-depth interviews were conducted with 15 patients and 6 informal caregivers based in China. Patients were eligible if they had completed primary diabetic foot treatment and had at least one other chronic condition. The SFM framework was used to inform the interview outline and data analysis. Results: Twenty-six themes were mapped onto the 5 domains of SFM as barriers and facilitators. These themes include (1) health status: high symptom burden and impaired cognitive function were prominent barriers, as well as (2) personal/lifestyle: emotional factors including fear and lack of knowledge. "Maintaining whole body" in the Chinese culture motivated patients and their families to perform SFM. (3) resources: financial and equipment constraints also hindered SFM. (4) environment: social network shaped attitude and involvement in SFM. (5) health care system: service access and relationship with health providers also shaped SFM's effect. Conclusion: Elucidating the impact factors identified in this study allows for a more systematic selection of strategies that may improve the design of effective interventions for diabetic foot patients with co-morbidity. Adding symptom management and dementia-friendly interventions to the current foot care program may improve accessibility and quality of care.