The Effects of Social Support and Hope in the Healing of Diabetic Foot Ulcers Treated with Standard Care

Diabetes mellitus is a common metabolic disorder that can cause various complications. Diabetic foot ulcer is a major complication of diabetes mellitus; although highly preventable, it has become a mental, physical, social, and economic burden affecting patients. ¹ Although wound care is an important aspect in diabetic foot ulcer management, other factors, such as the patient's emotional state, hope, life commitment, social support resources, and compliance with treatment, should be considered in its management. Holistic care, including social and psychological support, has not been well studied to date.

We performed a prospective cohort study to investigate the effects of “social support” and “hope” on 50% reduction of wound size after 4 weeks of treatment with standard care in patients who presented with Grade B, Stage I diabetic foot ulcer to the podology clinic of a university hospital in Kocaeli, Turkey.

The study sample consisted of patients aged ≥40 years, with type 2 diabetes, HbA1c concentration of >7%, and Grade B, Stage I diabetic foot ulcers according to the Texas Diabetic Wound Classification system. Patients with known risk factors affecting wound healing were excluded from the study.

The Beck Hopelessness Scale (BHS) and the Multidimensional Scale of Perceived Social Support (MSPSS) were used in this study. A 50% decrease in any wound size was considered reliable information about healing potential; 4 weeks was considered sufficient time to assess healing. ² All patients received standard care according to a diabetic foot ulcer study protocol developed by the researcher based on published guidelines. The researcher was trained for 4 months at the Steno Diabetes Center and Copenhagen School of Podiatry in management and care of diabetic foot ulcers.

Wound surface area (cm²) was calculated on days 1 and 30; it was calculated whether there was 50% reduction in wound surface area on days 1 and 30. BHS and MSPSS scores were compared between patients with or without a 50% reduction after 4 weeks. Data were analyzed using SPSS computer software version 15.0 (SPSS, Inc., Chicago, IL). MSPSS scores were higher in patients with over 50% reduction in wound size than those with less than 50% reduction (Mann-Whitney U Test, P = 0.001). A positive correlation was noted between family social support and percentage of recovery (r = 406, P = 0.01); the rate of recovery increased with increased family social support. BHS showed that self-perceived motivation loss scores of patients with over 50% reduction in wound size was lower than that of those with less than 50% reduction in wound size (Mann-Whitney U Test, P = 0.03) A negative correlation was found between social support from the family and hopelessness (r = −0.539, P = 0.01). Furthermore, a negative relationship was detected between total score of social support and hopelessness score (r = −0.449, P = 0.01).