A Collaborative Approach in Diabetes Foot Education - A Pragmatic Randomised Control Trial

Traditional directive style of requesting or demanding compliance to set behavior is found to have little effect on patient's self-care behavior. It is reported that patients prefer to restate or rephrase their understanding in a care setting, instead of a directive/didactic approach where the clinician provides 'one-way' information. In fact, directive persuasion is thought to lead to resistance to change and is counter-effective. New approaches such as open ended communication, interview style and collaborative approach is found to engage patients better in their own care and elicit patient's own intrinsic motivations for making changes. One way to do this is to invite patient to share their thoughts or concerns then clarify patient's understanding From their responses: (3a) affirm patient's correct understanding or (3b) address misconceptions with permission. In this study, the investigators will randomize 240 subjects into two groups: Group A will undergo the above describe collaborative approach to patient education and counselling; Group B will undergo current (traditional, didactic approach) patient education. It is hypothesized that the collaborative approach group (Group A) should experience better understand of their health condition and foot ulcer, be better able to adhere to treatment plan through collaborative participation and overall be more satisfied with the treatment. Outcomes will be tracked at (i) post intervention and (ii) 4 months post intervention.

Using a collaborative approach to engage patients in their own care, allowing patients to continue to have full control of their treatment. The clinician and patient co-creates the treatment plan.

Inclusion Criteria: Diagnosed type II diabetes Above age 21 Plantar foot ulcer - high risk with active full-thickness ulcer Pedal pulses palpable or min toe pressure of 30mmHg Medium of language: English Activities of daily living (ADL) independent (without carer) Exclusion Criteria: Diagnosed mental health conditions Diagnosed cognitive impairment Diagnosed visual impairment Diagnosed hearing and speech disabilities

Individual participant data will only be available to the PI. The study team will be analysing de-identified data

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