Urgent gaps in the provision of diabetes foot care in the Cape Metropole of South Africa: a qualitative study
1
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
2
Division of Endocrinology, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1724
ABSTRACT
INTRODUCTION:
Diabetes foot complications contribute to morbidity and mortality worldwide(1–3). Evidence-based foot screening and education are essential to prevent ulceration and amputation(4). We aimed to explore patient and healthcare provider (HCP) experiences of diabetes footcare, and to ascertain contextual data to inform a new footcare pathway.
METHODS:
We collected qualitative data at two public hospitals in Cape Town in 2024. Interviews and focus groups were conducted in English and isiXhosa, audio-recorded, transcribed and translated into English. Thematic analysis was done in NVivo(5,6). Ethics approval (UCT HREC ref 713/2023) was obtained. Participants provided informed consent.
RESULTS:
Fourteen HCP and twelve patient interviews, and two patient focus groups (n = 7), were conducted (n=33). We developed three key themes: (1) Patient awareness and engagement: patients rely on doctors to initiate footcare discussions, with consultations focused on medications. Despite decades with diabetes, patients’ feet were overlooked, leaving many unaware of risks until complications arose. Feelings of shame and stigma were common when discussing removing shoes and socks. (2) HCP challenges: HCPs wished patients to be more proactive in consultations and highlighted time constraints, patient load, and lack of training as barriers to conducting foot assessments. (3) Integration into routine care: HCPs welcomed integration of a focused foot screening using task-shifting. Patients valued visual and tangible feedback from foot screening, such as sensation loss, and recognised its educational role in linking nerve and vascular complications of diabetes.
CONCLUSIONS:
There is an opportunity to reduce healthcare costs and disability for people with diabetes through investing in foot screening pathways within primary care. HCPs highlighted a care pathway is lacking for patients who screen ‘at-risk’ of developing complications, but do not meet a threshold for amputation. A focused, evidence-based foot screening integrated into routine care may provide value and offer opportunity to empower patients.
Diabetes foot complications contribute to morbidity and mortality worldwide(1–3). Evidence-based foot screening and education are essential to prevent ulceration and amputation(4). We aimed to explore patient and healthcare provider (HCP) experiences of diabetes footcare, and to ascertain contextual data to inform a new footcare pathway.
METHODS:
We collected qualitative data at two public hospitals in Cape Town in 2024. Interviews and focus groups were conducted in English and isiXhosa, audio-recorded, transcribed and translated into English. Thematic analysis was done in NVivo(5,6). Ethics approval (UCT HREC ref 713/2023) was obtained. Participants provided informed consent.
RESULTS:
Fourteen HCP and twelve patient interviews, and two patient focus groups (n = 7), were conducted (n=33). We developed three key themes: (1) Patient awareness and engagement: patients rely on doctors to initiate footcare discussions, with consultations focused on medications. Despite decades with diabetes, patients’ feet were overlooked, leaving many unaware of risks until complications arose. Feelings of shame and stigma were common when discussing removing shoes and socks. (2) HCP challenges: HCPs wished patients to be more proactive in consultations and highlighted time constraints, patient load, and lack of training as barriers to conducting foot assessments. (3) Integration into routine care: HCPs welcomed integration of a focused foot screening using task-shifting. Patients valued visual and tangible feedback from foot screening, such as sensation loss, and recognised its educational role in linking nerve and vascular complications of diabetes.
CONCLUSIONS:
There is an opportunity to reduce healthcare costs and disability for people with diabetes through investing in foot screening pathways within primary care. HCPs highlighted a care pathway is lacking for patients who screen ‘at-risk’ of developing complications, but do not meet a threshold for amputation. A focused, evidence-based foot screening integrated into routine care may provide value and offer opportunity to empower patients.
| eISSN: | 2654-1459 |
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