Barriers and enablers to delivering preventative and early intervention footcare to people with diabetes: a scoping review of healthcare professionals’ perceptions

Objectives: To examine barriers and enablers to delivering preventative and early intervention footcare to people with diabetes, from the perspective of healthcare professionals within primary care. Methods: MEDLINE, CINAHL and Scopus databases as well as Google Scholar were searched in September 2018. Inclusion criteria: English, qualitative and quantitative studies, since 1998, reporting on barriers and/or enablers, as reported by primary care health professionals, to delivering preventative and/or early intervention footcare to people with diabetes. Results: 339 studies were screened. Eight studies met inclusion criteria. Perceived barriers to providing diabetes-related footcare included: geographical, administrative and communication factors, referral and care guideline availability and implementation challenges, limited availability of specialists and high-risk foot services, and limited resources including time and funding. Enablers to footcare were: implementation of footcare programs, education and training, clear definition of staff roles, development of reminder systems for healthcare professionals to conduct foot assessments and reminders for people with diabetes to remove their shoes at appointments. Conclusion: The barriers and enablers to footcare faced by healthcare professionals are multifaceted. Healthcare professionals are affected by health system and individual factors when delivering preventative and early intervention footcare to people with diabetes. By implementing strategies to address barriers to footcare delivery, it is possible to improve outcomes for people with diabetes reducing the impact of diabetes-related foot disease.