Gaps in promoting self-care to their patients
Experiences of podiatrists in the delivery of routine foot care with self-management
Study performed at the Ng Teng Fong General Hospital, Singapore.
The complexity of the demand for podiatry nail care services, focusing on podiatrists’ perspectives. This emphasized the importance of effective communication with patients to clarify the purpose of podiatry and to ensure sustainable podiatry care for the future.
Onychauxis and onychomycosis are some of the many nail issues affecting older peoples’ social and emotional well-being. Historically, podiatrists have been involved in nail cases, diabetic limb salvage, and musculoskeletal conditions. With the limited amount of podiatrists and rising demand for podiatric services, some governments have reconsidered podiatrists’ scope of practice and prioritization of services. The United Kingdom (UK) has adopted strategies to encourage less dependence on healthcare institutions for nail care, encouraging patients to self-care instead.
Singapore’s podiatry profession was established in 1993. According to an informal survey conducted by the Podiatry Association Singapore in 2021, all 127 podiatrists were trained overseas due to lacking a local program. Podiatric care is available in public and private healthcare, with private care offering non-subsidized but faster appointments. In Singapore, non-healthcare providers (pedicurists) provide basic foot care services.
Singapore’s aging population amplifies the urgency to optimize podiatry services, especially with the current shor tage of podiatrists. Singapore lags in podiatrist-to-population ratio compared to global standards. In 2021, the Singapore population stood at a ratio of 2 podiatrists per 100,000 people. Comparatively, New Zealand has a ratio of approximately 8.5 podiatrists per 100,000 people, whereas Australia and the UK estimate 20 podiatrists per 100,000 people.
Researcher reflexivity
As podiatrists within the acute setting, we were interested in understanding how podiatrists’ perspectives may corroborate in general care and self-management. Acknowledging the potential for a dependent relationship between researchers and interviewees, the researchers established clear boundaries, assured participants confidentiality, and empha-sized non-judgmental inquiry. As podiatrists, the researchers could empathize with participants’ experiences, which might influence the questioning direction.
Four major themes were identified
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#2 - Sports Related Foot & Ankle Injuries
Writing a dissertation on The Podiatrist as a Member of the Sports Medicine Team presented several barriers, primarily of which is the paucity of information on said topic. In no way was the search for information comparable with a topic such as Advances in Achilles Tendon Rehabilitation, where the medical literature and associated evidence is robust.
Discussion
This paper showed that podiatrists understand the value of providing nail care. This is supported by Farndon et al. that having a podiatrist to treat nails and keratotic lesions can help sustain foot health and reduce pain in 75% of patients. Menz further emphasized the importance of nail care for older individuals’ foot health, although toenail cutting is often considered less critical. However, our participants suggested that podiatrists may not significantly value trimming non-pathological toenails, which aligns with Vernon et al.’s recommendation that foot care is valuable without necessarily requiring professional intervention.
Menz and Woodrow et al. highlighted the strain on podiatrists’ resources and suggested the potential involvement of nursing staff to address this issue. The study by Wallis et al. on declining podiatrist numbers in England underscores the potential challenges faced in Singapore, where podiatrists were trained. Consequently, prioritization of cases, as noted in our study, becomes essential, with some podiatrists expressing a preference to delegate non-pathological nail cases. The success of transferring nail care responsibilities to other medical or social sectors varies across countries.
Patients typically seek podiatric help due to physical limitations, lack of familial support, or low motivation for self-management. Miikkola et al. suggested that older individuals who seek foot care help do not involve their immediate family, possibly due to the perception that foot care is intimate and prefer to entrust it to healthcare professionals. Our study indicates that new patients are often receptive to self-managing nail-related conditions, aligning with recommendations for early encouragement of self-management and safe discharge. Dineen-Griffin et al. highlighted the need to provide patients with the knowledge, resources, and self-efficacy so that they can manage their nails. However, implementing self-management strategies may be challenging, as some patients require time to adjust and may seek podiatric care continually without any behavioral changes. Additionally, two participants shared that implicit biases may hinder self-management education, prolonging patients’ reliance on the healthcare system.
Our participants highlighted the importance of patient-centered education strategies, which may include verbal explanations and demonstrations to enhance self-mana-gement skills. Literature showed that there is no universally superior communication method and supported the need for tailored approaches to self-management by recom mending various communication methods to maxi-mize learning. However, education alone may not lead to behavioral change, necessitating ongoing discussions and support from healthcare professionals. Instrumental and psychosocial support from family members is associated with better self-management. Ultimately, patients must possess the knowledge, skills, and confidence to manage their health to potentially reduce reliance on podiatry services and lessen the healthcare financial burden
The consolidated criteria for reporting qualitative research (COREQ) was used in this study to ensure its rigor. To the authors’ knowledge, this is the first study done in Singapore that seeks to understand podiatrists’ views on nail care. Participants shared their opinions freely throughout the interview. The population of podiatrists interviewed was considered representative of the private and public sectors of Singapore. This study considered podiatrists’ perspective of nail care in Singapore. More can be done to discover patients’ and families’ perspectives on adherence to nail self-management habits. This will shed light on any differences between the clinicians’ and patients’ perceptions and expand the understanding of the current motivations and barriers patients face in foot care.