RT Journal Article
SR Electronic
T1 A Scoping Review of Footwear Worn by People With Diabetes in Low- and Middle-Income Countries: Implications for Ulcer Prevention Programs
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2200392
DO 10.9745/GHSP-D-22-00392
VO 11
IS 2
A1 Reddie, Madison
A1 Shallal, Christopher
A1 Frey, Daniel
YR 2023
UL http://www.ghspjournal.org/content/11/2/e2200392.abstract
AB Key FindingsFew people with diabetes in low- and middle-income countries wear footwear recommended by international guidelines for ulcer prevention.Poverty, culture, climate, health literacy, and the nature of health care in low- and middle-income countries are barriers to implementation of international ulcer prevention guidelines.Key ImplicationPublic health officials and clinicians in low- and middle-income countries should consider whether they are well served by current international diabetic foot ulcer prevention guidelines and work with diabetic foot experts to develop more practical strategies and programs for low-resource contexts.International guidelines advise people with diabetes to wear close-toed, thick-soled footwear to protect against foot ulceration. However, this type of footwear is incompatible with some of the cultures, climates, and socioeconomic conditions in many low- and middle-income countries (LMICs). This scoping review aims to summarize what is known about footwear used by people with diabetes in LMICs and consider whether international diabetic foot guidelines are practical and actionable in these contexts, given current practices. PubMed, CINAHL, Scopus, Embase, Web of Science, Latin American and Caribbean Health Sciences Literature, and African Journals Online were searched for articles that documented the footwear used by people with diabetes in LMICs. Twenty-five studies from 13 countries were eligible for inclusion and indicated that a large proportion of people with diabetes wear footwear that is considered inappropriate by current guidance, with sandals and flip-flops being popular choices in a majority of the studies. Reasons given for these choices include poverty, lack of awareness of and provider communication about the importance of footwear selection, comfort, and cultural norms. We recommend that LMIC health care systems relying on international guidelines critically consider whether their recommendations are sensible in their settings. Diabetic foot experts and LMIC-based health care stakeholders should collaborate to design alternative guidelines, strategies, and interventions specifically for LMIC contexts to increase preventative practice feasibility and uptake.