From research to action: strengthening diabetes foot screening in South Africa through participatory research with patients and healthcare providers
1
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
2
Division of Endocrinology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
3
Engaged Research Consultant, Sustainable Livelihoods Foundation, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1708
ABSTRACT
INTRODUCTION:
Diabetes-related foot complications remain a leading cause of preventable hospitalisation and lower limb amputation in South Africa, disproportionately affecting people reliant on public-sector care. Despite guideline recommendations(1), routine diabetes foot screening is inconsistently implemented – constrained by time pressures, resource limitations, and misaligned patient and provider experiences(2–5). Participatory action research(6,7) and co-design principles(8) can address these gaps by co-producing contextually relevant solutions.
METHODS:
A 6.5-hour participatory action research workshop was conducted in November 2025 at a public-sector diabetes clinic in Cape Town. People with diabetes (n=11) and healthcare providers (n= 10) were recruited. The workshop combined facilitated group discussions, a practical demonstration of evidence-based foot screening, and developing a foot screening guide(9) and a video advocating for improved care pathways(10). Data was generated through flip charts and group feedback activities, and were analysed using thematic analysis(11,12).
RESULTS:
Foot screening was inconsistently prioritised, with patients reporting feelings of fear, shame, and uncertainty regarding foot examination. Healthcare providers highlighted workload pressures, limited training, and unclear role ownership. Both groups identified clear communication, respecting dignity, and building trust as central to footcare. The co-design process illuminated the need for standardised foot screening approaches, practical training for healthcare providers embedded in routine workflows, clearer role delineation, and improved patient education. Participants idenitified small changes that could be implemented within existing system resources (i.e., footcare education on community WhatsApp platforms) alongside the need for ambitious policy and service-level reforms.
CONCLUSIONS:
Social, emotional, and structural factors influencing diabetes foot screening are often overlooked in guideline-driven approaches. Investing in patient-and user-centred foot screening delivery within primary care, alongside clear referral pathways to podiatry and ancillary services for feet at-risk of progression to an amputation, may reduce preventable complications, lower health system costs, and improve the quality of life and well-being of people with diabetes.
Diabetes-related foot complications remain a leading cause of preventable hospitalisation and lower limb amputation in South Africa, disproportionately affecting people reliant on public-sector care. Despite guideline recommendations(1), routine diabetes foot screening is inconsistently implemented – constrained by time pressures, resource limitations, and misaligned patient and provider experiences(2–5). Participatory action research(6,7) and co-design principles(8) can address these gaps by co-producing contextually relevant solutions.
METHODS:
A 6.5-hour participatory action research workshop was conducted in November 2025 at a public-sector diabetes clinic in Cape Town. People with diabetes (n=11) and healthcare providers (n= 10) were recruited. The workshop combined facilitated group discussions, a practical demonstration of evidence-based foot screening, and developing a foot screening guide(9) and a video advocating for improved care pathways(10). Data was generated through flip charts and group feedback activities, and were analysed using thematic analysis(11,12).
RESULTS:
Foot screening was inconsistently prioritised, with patients reporting feelings of fear, shame, and uncertainty regarding foot examination. Healthcare providers highlighted workload pressures, limited training, and unclear role ownership. Both groups identified clear communication, respecting dignity, and building trust as central to footcare. The co-design process illuminated the need for standardised foot screening approaches, practical training for healthcare providers embedded in routine workflows, clearer role delineation, and improved patient education. Participants idenitified small changes that could be implemented within existing system resources (i.e., footcare education on community WhatsApp platforms) alongside the need for ambitious policy and service-level reforms.
CONCLUSIONS:
Social, emotional, and structural factors influencing diabetes foot screening are often overlooked in guideline-driven approaches. Investing in patient-and user-centred foot screening delivery within primary care, alongside clear referral pathways to podiatry and ancillary services for feet at-risk of progression to an amputation, may reduce preventable complications, lower health system costs, and improve the quality of life and well-being of people with diabetes.
| eISSN: | 2654-1459 |
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