The goal of this observational study is to create and evaluate and new management, by using eHealth tools, to prevent diabetic foot ulcers. The main questions it aims to answer are:
1. Validation
a. Is a method for foot assessment, that uses eHealth tools, valid regarding its usefulness? b. Is a method for foot assessment, that uses eHealth tools, reliable regarding the generated risk stratification? 2. Mapping
1. How do health care professionals and patients with diabetes experience that the future foot examination should be designed? 2. What experiences have health care professionals and patients with diabetes to use an eHealth tool supporting the annual foot examination? 3. Interviews - to use a paper format supporting a structured foot assessment
a. How do health care professionals experience to use a structured foot form, in paper form? 4. Interviews - footwear
a. What factors that influence how patients with diabetes choose their footwear? 5. Interviews - usability test of using an eHealth tool
a. How could a digital eHealth tool be designed? b. How could a digital eHealth solution be implemented, managed and spread in public health care setting? i. Participants will:
1\. fill in questionnaires 2. be interviewed 3. test eHealth solutions supporting the foot examination
6\. Experiences of using an eHealth tool supporting the foot assessment
a. How could a digital eHealth tool be designed?
7\. Questionnaires regarding self-perceived quality of life, the experiences of the visit at the care unit, transportation to the care unit.
a. Patients that visits care fills in a questionnaire regarding self-perceived quality of life (EQ-5D), a modified version of National Patient Survey, the diabetes questionnaire and a questionnaire regarding their travels and time for travels to and from the visit to the care unit.
8\. Critical evaluation of complexity
1. Exists complexity in the development, test, management, spread and sustain of an eHealth tool supporting foot examination and self-care of the feet in diabetes. 2. How could a digital eHealth solution be implemented, managed and spread in public health care setting?
9\. Long term effect
a. What is the long-term effect of using an eHealth tools supporting a structured foot examination?
Persons with diabetes being treated in Region Västra Götaland
Understand spoken and written Swedish
Professionals working with patients with diabetes having foot complications.
Working in Region Västra Götaland
Understand spoken and written Swedish
Patients Patients living in Region Västra Götaland being treated in a care unit in the same region. Professionals Professionalsm working in Region Västra Götaland being treating patientes in a care unit in the same region.
Case-control
Prospective
Patients being foot examined by using an eHealth tool
Other interventionPatients being foot examined by using an eHealth tool that has been developed, will be tested with the intention to implement the eHealth tool
Patients being foot examined in traditional manner
Other interventionPatient are being foot examined in the way as health care professionals usually make the foot examination in patients with diabetes
Validation
A valid foot examination routine is developed and presented in paper format.
Mapping
A variety of points of views are gathered regarding how the future foot care process should be managed. The method used Concept Mapping, is a methodology for mapping ideas that integrates input from multiple sources with differing expertise or interest, creates maps with multivariate data analyses that depict the composite thinking of the group, and yields data that allows for comparisons across rating criteria, stakeholder groups, different points in time, etc. to aid in targeted planning, implementation strategies, and evaluation. Group concept mapping is related to the growing interest in the role that theory plays in planning and evaluation.
Interviews - to use a paper format supporting a structured foot assessment
Experiences regarding how do health care professionals experienced it to use a structured foot form, in paper form will be gathered using qualitative content analysis, as described by Graneheim and Lundman, is considered appropriate in order inductively to focus on and describe experiences and variations on an individual level and to identify differences and similarities on a manifest and latent level. The analysis will be conducted in several steps. First, all the data will be read several times to ensure immersion in the data. All interview text will be regarded as a unit of analysis. The text will then be divided into "meaning units" that corresponded to the aim of the study. Each meaning unit will be condensed and labelled with a code. Codes are described as concrete and as close to the text as possible. Semi-structured interviews will be held with two focus groups and individual interviews.
Interviews - footwear
Factors are summarized regarding how patients with diabetes choose their footwear will be gathered using qualitative content analysis, as described by Graneheim and Lundman, is considered appropriate in order inductively to focus on and describe experiences and variations on an individual level and to identify differences and similarities on a manifest and latent level. The analysis will be conducted in several steps. First, all the data will be read several times to ensure immersion in the data. All interview text will be regarded as a unit of analysis. The text will then be divided into "meaning units" that corresponded to the aim of the study. Each meaning unit will be condensed and labelled with a code. Codes are described as concrete and as close to the text as possible. Semi-structured interviews will be held with two focus groups or individual interviews.
Questionnaires regarding self-perceived quality of life, the experiences of the visit at the care unit, transportation to the care unit.
Summaries regarding self-perceived quality of life, the experiences of the visit at the care unit, transportation to the care unit are made. Self-perceived quality of life is measured with EQ-5D, a standardised, reliable and valid measurement of health status developed by the EuroQol Group in order to provide a simple, generic measurement of health for clinical and economic appraisal. The answers kan be levelled in: 1) I have no problems…, level 2) I have slight problems…, 3) I have moderate problems…,4) I have severe problems…,5) I am unable to… Experiences of the visit at the care unit will be measured with a modified version of the national Swedish patient survey. Transportation to the care unit will be registered in km and hour/minutes
Critical evaluation of complexity
By using the NASSS CAT framework: Non-adoption, Abandonment, Scale-up, Spread, and Sustainability of health technology; CAT: complexity assessment tool) complexities are explored and managed in the development, test, management, spread and sustain of the eHealth tool.
Long term effect
The Researchers will compare long-term outcomes from the intervention group with a comparison group consisting of medical record data of patients from a couple of primary care centers for following parameters, measured in numbers of patients that: 2\. had an annual foot examination 3. had a digital annual foot examination 4. have a diabetic foot ulcer 5. had an amputation in the lower extremities 6. risk grad (1-4) 7. recieved podiatry and 8. location for foot care (at home, mobile team)
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Sahlgrenska University Hospital
Lead sponsor
Vastra Gotaland Region
Collaborator
