The assessment and management of diabetes related lower limb problems in India‐an action research approach to integrating best practice

Abstract

BackgroundIn this article the authors explore the current issues and barriers related to achieving successful outcomes to diabetic foot complications in India. This was achieved by engaging clinicians in taking ownership of the problems and facilitating them in the identification of solutions to action change in clinical practice.MethodsThis was accomplished through facilitating participants in this study via a process of problem identification and planning, the first phases of an action research cycle approach. The methods of data collection were focus groups, observations and individual conversations. The data were analysed using a thematic framework.ResultsBased on the practitioner’s experiences and opinions, key themes were identified. These themes had the potential to inform the changes needed in clinical practice, to overcome barriers and embed ownership of the solutions. Five themes were identified highlighting: concerns over a fragmented service; local recognition of need; lack of standardised care pathways; lack of structured assessment and an absence of annual foot screening. Combined, the issues identified were thought to be important in preventing timely assessment and management of foot problems.ConclusionIt was unanimously agreed that a formalised process of foot assessment should be developed and implemented as part of the subsequent phases of the action research process, which the authors intended to take forward and report in a further paper. The aim of which is to guide triage, education, care pathways, audit and evaluation of outcomes. Facilitation of the clinicians in developing a program and screening tool to implement and teach these skills to others could be an important step in reducing the number of high-risk cases that are often resulting in the amputation of limbs.

Screening behaviors for diabetic foot and their influencing factors among general practitioners: a cross-sectional study in Changsha, China

“…In addition, lack of time and energy and limited equipment was also found to be important factors affecting general practitioners' foot screening. Previous studies in different countries have also shown that limited time during healthcare professionals' consultations may result in foot assessments being overlooked [30][31][32], as macrovascular complications and HbA1c monitoring were the primary focus in busy practices. Although the number of general practitioners is constantly growing in China, it still cannot meet the screening needs of large populations of diabetic patients just like in other developing countries, and thus general practitioners may not be able to provide each patient with a full range of services [33].…”

Prioritisation of diabetes‐related footcare amongst primary care healthcare professionals

“…Harrison‐Blount et al. (2014) identified that routine foot examinations were not conducted, due to time restraints and resource limitations, unless the patients themselves drew attention to a foot problem. Whilst it is encouraging that footcare actions such as wound care, foot assessments, referrals to podiatry and specialist tertiary diabetic foot clinics became higher priorities for healthcare professionals in the presence of acute diabetes‐related foot complications, the International Working Group of the Diabetic Foot (IWGDF) promotes preventative strategies to support footcare and prevent ulcerations (Bus et al., 2020).…”

An action research approach to facilitating the adoption of a foot health assessment tool in India

“…Effective implementation of change in foot care services, such as the use of new assessment tools, requires a tailored approach that is sensitive to the local factors affecting change. Previous work has identified the need to use different approaches, methods and therapeutic strategies in the Eastern (or Indian) context to achieve the goal of transferring evidence based guidelines [3][4][5]. Furthermore research has explored the need for understanding the values required to successfully embed evidence based practice [6][7][8].…”

“…In the first paper of this series [5] researchers used an action research approach to illustrate the importance of process and engagement in driving change and the adoption of evidence based practices by those associated with foot health management in India. The work utilized the problem identification and action-planning phases of the action research process [5] in order to support change in foot care in one locality in India.…”

“…In the first paper of this series [5] researchers used an action research approach to illustrate the importance of process and engagement in driving change and the adoption of evidence based practices by those associated with foot health management in India. The work utilized the problem identification and action-planning phases of the action research process [5] in order to support change in foot care in one locality in India. This was successful in achieving local ownership and identification of the clinicians own problems and, specifically, a desire to develop and implement a foot health screening/assessment tool as a potential solution.…”