'Diabetes Makes You Lose Your Leg': Footcare Self-Management Amongst I-Taukei Fijians-A Wearable Camera Study

Abstract

Issue addressed: Footcare is an integral part of diabetes self-management, yet there is limited research on diabetes footcare self-management. This paper explores footcare self-management and the impact of diabetes foot complications amongst I-Taukei Fijians in Fiji.

Methods: This mixed-method research examines data from the innovative Fijian Diabetes Cam study, consisting of photographic images, photo-elicitation interviews, and researcher observation. A strategic sample of 30 I-Taukei Fijian adults with diabetes participated. Participants wore a camera that photographed their activities, behaviour, and environment every 7 s for 4 days. Images were used in semi-structured photo-elicitation interviews at home, with the images as prompts. Image data and observation were descriptively analysed, while photo-elicitation responses were thematically analysed.

Results: While all participants said they performed footcare, for most this was limited to looking for cuts and wounds. Those with foot complications such as amputations have to leave employment. Facilitators included family and community support. Key barriers included the lack of preventive health services and support; poor resourcing and accessibility of dressing supplies, blood sugar testing kits and mobility aids and the warm climate hindering the wearing of closed shoes. Access to appropriate housing and transportation were also key barriers for those with amputations.

Conclusions: This study suggests that I-Taukei patients recognise the need for footcare self-management and are largely motivated to do it. However, there is a lack of health education and the health service lacks the resources and trained staff to meet the needs of the people. The underfunded and under-resourced health system is a major contributor. Nevertheless, there are opportunities to improve health promotion actions. SO WHAT?: Health promotion approach to diabetes footcare self-management in Fiji could significantly improve the lives of people living with diabetes and reduce the risk of complications and amputation. Donor countries and WHO need to consider the support provided to assist Fiji to manage this increasingly challenging public health issue.

Keywords: Fiji; diabetes; foot amputations; footcare; self‐management.

FIGURE 1

(a) This picture shows a study participant preparing their amputation site for wound dressing. (b) This picture illustrates the participant using reusable materials for wound dressing at home.

FIGURE 2

(a) This picture shows a study participant moving from a taxi to a wheelchair at a health clinic. (b) Image depicts a crutch lying by the door and a study participant with multiple leg wounds.

FIGURE 3

(a) Image shows steep steps outside leading to a participant's house. (b) A long walkway outside is shown leading to a house. (c) Steep steps that can be seen on the slope.

FIGURE 4

(a) This picture shows inadequate access to the house. (b) The image shows that the participant uses a wheelchair, but the house has no ramp.

FIGURE 5

(a and b) Image shows a participant crawling around the house. (c) Image shows a participant sitting in a wheelchair in his home.

FIGURE 6

(a) Image shows a daughter performing wound care for her father with a BKA. (b) This picture shows a participant's son assisting in washing the clothes, supervised by his mother, who has a BKA. (c) Image showing a participant's son hanging the clothes outside on the line, supervised by his mother, who has a BKA.