Diabetic foot screening programs through an implementation science lens: A rapid review.

Area of Science:

• Public Health
• Implementation Science
• Global Health

Background:

• Diabetes-related foot conditions are a major cause of amputations and mortality worldwide.
• Current annual foot screening implementation is insufficient and inequitable, despite international guidelines.
• Primary care settings are key for diabetic foot screening programs.

Purpose of the Study:

• To synthesize evidence on primary care diabetic foot screening programs.
• To examine barriers and facilitators using the Consolidated Framework for Implementation Research (CFIR).
• To map implementation strategies with an equity lens.

Main Methods:

• A rapid review following PRISMA guidelines, searching MEDLINE, EMBASE, and CINAHL.
• Data extraction focused on program components, equity factors (PROGRESS+), and CFIR determinants.
• Narrative synthesis and CFIR-based analysis of barriers, facilitators, and strategies.

Main Results:

• 44 studies from 16 countries, predominantly high-income settings.
• Programs integrated screening into workflows, used risk stratification, and multidisciplinary teams.
• Facilitators included guidelines, EHRs, adaptation, leadership; barriers included resources, turnover, fragmentation, and economic access issues.

Conclusions:

• Diabetic foot screening programs have common elements but face equity and sustainability challenges.
• Implementation informed by CFIR analysis and equity principles can reduce global amputations.
• Systematic outcome stratification by sociodemographic subgroups is needed.