Methodological considerations of investigating adherence to using offloading devices among people with diabetes

Figures & data

Table 1 Summary of dominating approaches in current research and recommendations for future studies

Aspect	Dominating approaches in current research	Recommendations for future studies
Study designs	Cross-sectional, observational	Use longitudinal study designs with observational studies to identify nonadherent patient groups and factors affecting adherence and experimental studies to evaluate interventions to improve adherence
Definitions of adherence	Wearing time^Citation7^–^Citation10,Citation13,Citation15,Citation23,Citation31,Citation34,Citation36,Citation37 or number of steps taken with the device^Citation12,Citation14,Citation17,Citation32,Citation44,Citation45	Define adherence as device use during all weight-bearing activities
Methods to measure adherence	Interviews,^Citation10,Citation11,Citation13,Citation31,Citation36,Citation37 questionnaires,^Citation7,Citation8,Citation15,Citation18,Citation23,Citation34,Citation41 temperature monitors,^Citation9,Citation12,Citation14,Citation43^–^Citation45 pedometers,^Citation12,Citation14,Citation17,Citation32,Citation44,Citation45 and accelerometers^Citation16	Use objective methods (accelerometers and temperature monitors) whenever possible. Validated questionnaires can be used for surveys
Conceptual frameworks	Frameworks not defined and focus on a narrow range of factors (eg, patient-, therapy-, and condition-related factors)	Use clearly defined frameworks (eg, the health belief model or the common-sense model of illness behavior) and include a wider range of factors (eg, social and economic circumstances, health system-related factors, locus of control, self-efficacy, and a time/process perspective)

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