Diabetes-related foot interventions to improve outcomes for Indigenous peoples in high-income countries: A scoping review

Purpose

Indigenous peoples from high income countries experience health disparities attributable to the ongoing legacy of colonisation and racism, including higher rates of diabetes and associated complications, including diabetes foot disease, in comparison to the relevant resident population. Providing culturally safe care through well-organised diabetes foot interventions can improve outcomes. This scoping review describes the range of publications detailing diabetes foot interventions that incorporated Indigenous peoples.

Methods

This scoping review followed the PRISMA-Scoping Review guide. Indigenous Māori perspectives were included in all stages of the review. Eligible publications described diabetes foot interventions that included Indigenous peoples from high-income countries. Key study characteristics included country, Indigenous population, intervention description, foot-related outcomes, and alignment with the CONSIDER statement domains for reporting on Indigenous involvement in health research.

Main findings

A total of 32 publications met the eligibility criteria, with publications from Australia (n = 14), Canada (n = 6), USA (n = 6), New Zealand (n = 2), Greenland (n = 2) and Nauru (n = 2). Primary prevention interventions were predominant (n=20) with a focus on increasing foot screening rates (n=16). Other interventions included health promotion and education (n=4), comprehensive foot interventions (n=5), foot care services embedded in undergraduate podiatry education, a diabetic foot ulcer management protocol, and a service brokerage model. Only 2 studies of the 29 evaluated reported all the CONSIDER statement domains.

Principal conclusions

Few publications described improved outcomes for Indigenous peoples and most interventions for diabetes-related foot disease overlooked Indigenous perspectives and health beliefs concerning feet. The CONSIDER statement provides useful guidance for all stages of research with Indigenous peoples and our findings suggest reporting Indigenous engagement could be strengthened.