Diabetic Foot Ulcer Prevention Priorities Established by Consumers From Low Socioeconomic and Culturally Diverse...

Diabetic foot ulcers (DFU) continue to occur despite established prevention guidelines, yet consumer perspectives, particularly from socioeconomically disadvantaged and culturally and linguistically diverse (CALD) communities, have been underrepresented in shaping prevention. To address this gap, we aimed to co-design a consumer-derived prevention research agenda by identifying barriers and enablers, establishing research priorities, prioritising implementation strategies, and defining meaningful outcome measures.

Four sequential workshops were conducted with 11 consumers with a history of DFU in South East Queensland, including Aboriginal and Pacific Islander participants (n = 4) and those from areas of socioeconomic disadvantage (n = 8). Rapid qualitative analysis informed iterative refinement across workshops, with priorities, implementation strategies, and outcome measures ranked by participants.

Participants identified barriers across clinical, self-care, psychosocial, social, and financial domains, including feeling unsupported when trying to prevent DFU, the cognitive burden of constant vigilance, conflicting guidance, and the financial and travel costs of care. The highest-ranked research priorities were better ways to predict problems before they happen (median 2, IQR 1-4.5), formal education support (median 4, IQR 3-9), and tools to support regular foot checks (median 5, IQR 3-6). Across all three priorities, consumers consistently selected technology enabled implementation strategies, including wearable sensors, AI powered personalised learning, and smart interventions. Participants defined prevention success through quality of life, function, and confidence outcome measures rather than clinical endpoints alone.

For socioeconomically disadvantaged and CALD populations, effective DFU prevention must be technology enabled, personalised, and developed in partnership with the consumer.