to encourage practitioners to reconceptualize
fit more broadly and find ways to discuss this
wider understanding of fit with their patients.
Although there is further research to be done
to consider how developments such as the
toolkit can more directly inform training and
practice, the findings of a range of previous
research suggest that tools such as Motivational
Interviewing (MI) are likely to be of value in
clinical settings [30] .
It is important to recognize the obstacles that
over-stretched practitioners may experience to
introducing meaningful dialogue through MI
34
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into clinical encounters, particularly in terms
of the limited time available in each patient
consultation [31] . Yet even small changes in the
ways in which practitioners communicate
with patients can have an influence on rates
of acceptance and adherence to treatment or
lifestyle changes [32] . MI is a consultation strategy
designed to facilitate an in-depth discussion
of patient values and motivations in order to
address and seek to resolve any ambivalences
towards behavior change [30] . Within a time
limited consultation, elements of what Gabbay
et al. [30] call ‘brief MI’ — open-ended questions,
reflective listening and summarizing – can
be used with impact to discuss and address
patient obstacles to making long-term footwear
changes.
Future directions and emerging research
Research in healthcare settings that draws
on social science theories, approaches and
methodologies can provide in-depth insights
into patient values and highlight the complex
relationships that patients may have with their
shoes and feet. Whilst the use of semi-structured
interviews is becoming more established in this
field, future research could make further use
of innovative methods (such as photography,
videos, shoe diaries, shoe shopping trips
with patients) which have until recently been
wearing shoes are complex. Recent research
in this field [27] has led to the development of an
online toolkit, recommendations for practice
and a visual tool, all designed to directly
inform practice in patient consultations and
‘A good fit?’