{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:56:41Z","timestamp":1791266201495,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T00:00:00Z","timestamp":1783814400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T00:00:00Z","timestamp":1783814400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Foot and Ankle Research"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetes\u2010related foot ulceration (DFU) is a serious complication that can lead to lower limb amputation or death. Custom\u2010made footwear is a key preventative strategy, yet adherence to use is often low. The factors influencing decision\u2010making for footwear use remain unclear, particularly among underserved groups such as people from low socioeconomic and South Asian backgrounds. This study aimed to identify the psychological mechanisms underlying footwear choice and adherence in people with diabetes from low socioeconomic and South Asian populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study used a qualitative approach conducted in two parts. Part 1 explored footwear\u2010related experiences using one\u2010to\u2010one interviews informed by the COM\u2010B model (which states that there are 3 components to Behaviour: Capability, Opportunity, Motivation). Findings from Part 1 informed Part 2, a \u2018think aloud\u2019 qualitative study examining reasoning strategies behind footwear choices. Participants were adults living with diabetes at moderate to high risk of foot ulceration, with or without prior foot ulcers or experience of therapeutic footwear. Those with active foot ulceration were excluded. Interview data were analysed using thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eleven UK\u2010based participants completed Part 1 (7 male, 4 female; median age 64; South Asian\u00a0=\u00a07; low socioeconomic status\u00a0=\u00a06). Seventeen themes were identified and categorised within the COM\u2010B framework to inform Part 2. Fourteen participants completed Part 2 (10 male, 5 female; median age 67; South Asian\u00a0=\u00a05; low socioeconomic status\u00a0=\u00a08). Two key reasoning mechanisms emerged: (1) Discomfort Avoidance Prioritised Over Clinical Advice, reflecting a tendency to prioritise comfort over medical recommendations, and (2) Desire for Normality, describing a preference for familiar or \u2018normal\u2019 footwear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Footwear decision\u2010making among people living with diabetes seems to be informed by reasoning based on discomfort avoidance and normalcy. These findings highlight the need for a person\u2010centred approach to footwear advice that may bridge the gap between footwear adherence and patients' reasoning mechanisms. These mechanisms must be confirmed in a replication study or in an appropriately large quantitative study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jfa2.70186","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T03:37:01Z","timestamp":1783913821000},"source":"Crossref","is-referenced-by-count":0,"title":["Discomfort Avoidance and Desire for Normality Are Decision\u2010Making Drivers of Footwear Choice in Underserved Communities at Risk of Diabetic Foot Ulcer"],"prefix":"10.1002","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8027-1665","authenticated-orcid":false,"given":"Krithika","family":"Anil","sequence":"first","affiliation":[{"name":"School of Health Professions, Faculty of Health University of Plymouth  Plymouth UK"},{"name":"Brain Research and Imaging Centre University of Plymouth  Plymouth 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