The Experiences of people in Northern Thailand living with Diabetic Foot Ulcers: A Descriptive Qualitative Study

Main Article Content

Saneh Khunkaew
Patraporn Tungpunkom
Jenny Sim
Ritin Fernandez


             Diabetic foot ulcers are a main cause of morbidity related to type 2 diabetes. Living with a diabetic foot ulcer has a significant impact on health-related quality of life and has a negative impact on daily living among people with the condition. The aim of this study was to explore the experiences of Thai adults living with diabetic foot ulcers using a descriptive qualitative design. Participants were recruited from the outpatient diabetes and foot clinic at a tertiary teaching hospital in Northern Thailand from January to April 2017. In-depth interviews were conducted with 13 participants using a semi-structured interview guide.

             Thematic analysis was used to identify the participants’ experiences and two themes were identified: 1) living with a diabetic foot ulcer and 2) managing a diabetic foot ulcer. The findings enhance the knowledge of healthcare professionals and the public to understand the experience of having diabetic foot ulcers and contribute to understanding how to manage a diabetic foot ulcer based on the participant’s experiences in the Thai context. Nurses must provide knowledge and self-care skills as part of routine care to improve health-related quality of life for people with diabetic foot ulcers.

Article Details

How to Cite
Khunkaew S, Tungpunkom P, Sim J, Fernandez R. The Experiences of people in Northern Thailand living with Diabetic Foot Ulcers: A Descriptive Qualitative Study. PRIJNR [Internet]. 2018 Sep. 28 [cited 2022 Nov. 29];22(4):304-18. Available from:
Original paper


1. Dunning T. Diabetes education: art, science, and evidence. Chichester, West Sussex: Wiley-Blackwell; 2013.

2. Whiting DR, Guariguata L, Weil C, Shaw J. Diabetes Atlas: IDF Diabetes Atlas: Global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Research and Clinical Practice. 2011 94:311-21.

3. Reutrakul S, Deerochanawong C. Diabetes in Thailand: status and policy. Current diabetes reports. 2016 16(3): 1-10.

4. WHO. Diabetes country profiles 2016 [cited 2018 February 6]. Available from: country-profiles/tha_en.pdf?ua=1.

5. Sadosky A, Schaefer C, Mann R, Bergstrom F, Baik R, Parsons B, et al. Burden of illness associated with painful diabetic peripheral neuropathy among adults seeking treatment in the US: results from a retrospective chart review and cross-sectional survey. Diabetes, Metabolic Syndrome And Obesity: Targets And Therapy. 2013 6:79-92.

6. Meetoo D. Diabetes: complications and the economic burden. British Journal of Healthcare Management. 2014 20(2):60-7 8p.

7. Bradbury SE, Price PE. Diabetic foot ulcer pain: the hidden burden (part one). EWMA Journal. 2011 11(1):11-22.

8. Burant CF, American Diabetes A. Medical management of type 2 diabetes. Alexandria, Va: American Diabetes Association; 2008.

9. Aekplakorn, Chariyalertsak S, Kessomboon P, Sangthong R, Inthawong R, Putwatana P, et al. Prevalence and management of diabetes and metabolic risk factors in Thai adults: The Thai national health examination survey IV, 2009. Diabetes Care. 2011 34(9):1980-5.

10. Sarinnapakorn V, Sunthorntepwarakul T, Deerochanawong C, Niramitmahapanya S, Napartivaumnuay N. Prevalence of diabetic foot ulcers and risk classifications in type 2 diabetes mellitus patients at Rajavithi Hospital. Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 2016 99(2):S99-S105.

11. Bakas T, McLennon SM, Carpenter JS, Buelow JM, Otte JL, Hanna KM, et al. Systematic review of health-related quality of life models. Health Qual Life Outcomes. 2012 10(1):134.

12. Chin Y-F, Liang J, Wang W-S, Hsu BR-S, Huang T-T. The role of foot self-care behavior on developing foot ulcers in diabetic patients with peripheral neuropathy: A prospective study. International Journal of Nursing Studies. 2014 (0).

13. Dixit S, Maiya A, Khetrapal H, Agrawal B, Vidyasagar S, Umakanth S. A questionnaire based survey on awareness of diabetic foot care in Indian population with diabetes: a cross-sectional multicentre study. Indian Journal Of Medical Sciences. 2011 65(10):411-23.

14. Kiani J, Moghimbeigi A, Azizkhani H, Kosarifard S. The Prevalence and Associated Risk Factors of Peripheral Diabetic Neuropathy in Hamedan, Iran. Archives of Iranian Medicine (AIM). 2013 16(1):17-9.

15. Abbas ZG, Lutale JK, Archibald LK. Diabetic foot ulcers and ethnicity in Tanzania: a contrast between African and Asian populations. International Wound Journal. 2009 6(2):124-31.

16. Chellan G, Srikumar S, Varma AK, Mangalanandan TS, Sundaram KR, Jayakumar RV, et al. Foot care practice - The key to prevent diabetic foot ulcers in India. Foot. 2012 22(4):298-302.

17. Holland CM. Diabetic peripheral neuropathy: a barrier to quality of life. Communicating Nursing Research. 2012 45:405.

18. Aekplakorn W, Chariyalertsak S, Kessomboon P, Sangthong R, Inthawong R, Putwatana P, et al. Prevalence and management of diabetes and metabolic risk factors in Thai adults: the Thai National Health Examination Survey IV, 2009. Diabetes care. 2011 34(9):1980-5.

19. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Research and Clinical Practice. 2014 103(2):137-49.

20. Thonghong A, Thepsittha K, Jongpiriyaanan P, Gappbirom T. Chronic disease surveillance report 2012. Wkly Epidemiol Surveill Rep Thail. 2013 44:800-8.

21. Wanchai A. Patient Experiences using Complementary and Alternative Medicine for Type 2 Diabetes Mellitus in Thailand. Pacific Rim International Journal of Nursing Research. 2017 21(4):331-40.

22. Lundberg PC, Thrakul S. Type 2 diabetes: how do Thai Buddhist people with diabetes practise self-management? Journal Of Advanced Nursing. 2012 68(3):550-8.

23. Lundberg PC, Thrakul S. Diabetes type 2 self-management among Thai Muslim women. Journal of Nursing & Healthcare of Chronic Illnesses. 2011 3(1):52-60.

24. Lundberg PC, Thrakul S. Religion and self-management of Thai Buddhist and Muslim women with type 2 diabetes. Journal of Clinical Nursing. 2013 22(13/14):1907-16.

25. Thorne S. Toward Methodological Emancipation in Applied Health Research. Qualitative Health Research. 2011 21(4):443-53.

26. Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills, Calif: Sage Publications; 1985.

27. NHMRC. National Statement on Ethical Conduct in Human Research Canberra: Australian Government; 2007 [cited 2018 February 6]. Available from: https://www.nhmrc.

28. Gill P, Stewart K, Treasure E, Chadwick B. Methods of data collection in qualitative research: interviews and focus groups. British Dental Journal. 2008 204(6):291-5.

29. Denzin NK, Lincoln YS. The Sage handbook of qualitative research / edited by Norman K. Denzin, Yvonna S. Lincoln: Thousand Oaks : Sage, c2011. 4th ed.; 2011.

30. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006 3(2):77-101.

31. Koch T. Establishing rigour in qualitative research: the decision trail. Journal of Advanced Nursing. 2006 53(1): 91-100.

32. Crowe M, Inder M, Porter R. Conducting qualitative research in mental health: Thematic and content analyses. Australian and New Zealand Journal of Psychiatry. 2015:0004867415582053.

33. Sandelowski M. Rigor or rigor mortis: the problem of rigor in qualitative research revisited. Advances in Nursing Science. 1993 16(2):1-8.

34. Guba EG, Lincoln YS. Fourth generation evaluation: Newbury Park, Calif. : Sage Publications, c1989.; 1989.

35. Polit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice. 9th ed. Sydney: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012.

36. Noor S, Zubair M, Ahmad J. Diabetic foot ulcer—A review on pathophysiology, classification and microbial etiology. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2015 9:192-9.

37. Kanai T, Matsuoka K, Naganuma M, Hayashi A, Hisamatsu T. Diet, microbiota, and inflammatory bowel disease: lessons from Japanese foods. The Korean journal of internal medicine. 2014 29(4):409.

38. Beattie AM, Campbell R, Vedhara K. ‘What ever I do it’s a lost cause.’ The emotional and behavioural experiences of individuals who are ulcer free living with the threat of developing further diabetic foot ulcers: a qualitative interview study. Health Expectations. 2014 17(3):429-39.

39. Ribu L, Birkeland K, Hanestad BR, Moum T, Rustoen T. A longitudinal study of patients with diabetes and foot ulcers and their health-related quality of life: wound healing and quality-of-life changes. J Diabetes Complications. 2008 22(6):400-7.

40. Ribu L, Hanestad BR, Moum T, Birkeland K, Rustoen T. A comparison of the health-related quality of life in patients with diabetic foot ulcers, with a diabetes group and a nondiabetes group from the general population. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2007 16(2):179-89.

41. Ribu L, Hanestad BR, Moum T, Birkeland K, Rustoen T. Health-related quality of life among patients with diabetes and foot ulcers: association with demographic and clinical characteristics. J Diabetes Complications. 2007 21(4):227-36.

42. Settakorn J, Rangdaeng S, Arpornchayanon O, Lekawanvijit S, Bhoopat L, Attia J. Why were limbs amputated? An evaluation of 216 surgical specimens from Chiang Mai University Hospital, Thailand. Archives of Orthopaedic and Trauma Surgery. 2005 125(10):701-5.