Key Improvements in Healthcare for Persons With Diabetes at Risk of Developing Foot Ulcers: A Concept Mapping Study

Diabetic foot ulcers (DFUs) are a serious complication of diabetes, with a lifetime risk of up to 34%. Despite preventive guidelines, gaps remain in the care chain. This study aimed to identify and prioritise improvements in DFU prevention, care, and self-care in the Region Västra Götaland, Sweden.

A participatory action research design was used as part of a larger observational co-design study. Patients with diabetes, healthcare professionals, and researchers participated. Data were collected through Concept Mapping to generate and cluster ideas, followed by a workshop to prioritise improvements. The improvements were assessed regarding feasibility and importance ranging from 0 to 7, with exceptions that some participants scored ideas > 7.

Thirty-one participants contributed and based on 83 ideas five clusters were generated: (1) Examination of the feet by healthcare professionals, (2) Exchange of knowledge/Exchange of experiences, (3) Access to podiatry, (4) Economy/Equal care, and (5) Other/Support for self-care. In a workshop with 22 participants, the three prioritised ideas were: (1) Having access to podiatry if problems occur, (2) Getting help when problems arise, and (3) Information from the healthcare about the importance of good foot healthcare. These ideas got 80% or more of all votes within each of the five clusters and were scored > 5 for feasibility and of > 7 for importance. Other prioritised ideas involved enhancing individual self-care capabilities and maintaining personalised interactions despite digitalisation.

Timely access to podiatry, increased foot health awareness among healthcare professionals, and rapid intervention when problems arise were identified as key priorities for improving DFU care and patient outcomes.