Educational strategy for the prevention and basic care of chronic wounds in Mayan-Yucatecan Indigenous communities

Chronic wounds are prolonged healing processes that affect the skin, with diabetic foot ulcers being among the most common. The incidence and prevalence of chronic wounds are increasing in tandem with the rise in non-communicable chronic diseases (NCDs). In Mexico, specifically in the state of Yucatán, the high prevalence of NCDs such as diabetes, hypertension, and obesity among adults, particularly in rural settings, contributes to the emergence of chronic wounds. In addition to this epidemiological landscape, structural factors - including lack of public transportation, discrimination, marginalization, and limited access to healthcare services - mean that the presence of chronic wounds among the Maya-Yucatecan Indigenous population represents a significant care challenge for both individuals and the health system. This project aimed to co-construct an educational strategy for wound prevention and basic care in the Maya-Yucatecan communities of the municipality of Chankom.

Chankom is a municipality located in the state of Yucatán in south-eastern Mexico. It is classified as having a very high degree of social marginalization, where 70% of the population is Indigenous and only 8% have access to health services. The main economic activities are agriculture and the production of handicrafts. The four phases of community-based participatory research were followed to identify the health needs of the population. In the first phase, healthcare personnel working in the Chankom commissariats were interviewed, and a focus group was conducted with women health leaders (WHLs). Chronic wounds were identified as a significant problem due to the prevalence of NCDs, the type of footwear, terrain, and daily activities in these communities, which have led to an increase in diabetic foot cases. Consequently, knowing how to care for a wound became a perceived need for the population. In the second phase, an educational strategy for wound prevention and basic care was co-constructed with the participating WHLs. In the third phase, a training workshop was conducted, comprising virtual theoretical sessions and one practical in-person session in the community, which was taught by a woundcare nurse. Finally, in the fourth phase, an eight-item questionnaire was administered to the WHLs before and after the workshop to evaluate knowledge acquisition, revealing a statistically significant increase in knowledge.

The high prevalence of NCDs in Mexico can lead to health problems related to traumatic wounds in Maya-Yucatecan communities, a consequence of daily activities and limited access to healthcare services. Interventions that are co-constructed alongside the community, which respond to specific population needs in a culturally appropriate way and considering locally available resources, have a positive impact. They foster community participation, contribute to the prevention of complications, reduce the burden on healthcare services, and diminish health inequities. Community-based projects are necessary to inform the development of evidence-based clinical practice guidelines and health policies that address the real needs of the population.