Corser Jenny, Yoldi Irantzu, Reeves Neil D, Culmer Pete, Venkatraman Prabhuraj D, Orlando Giorgio, Turnbull Rory Peter, Boakes Paul, Woodin Eric, Lightup Roger, Ponton Graham, Bradbury Katherine
Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, United Kingdom.
School of Health, Sport & Bioscience, University of East London, London, United Kingdom.
J Particip Med. 2025 Feb 14;17:e59608. doi: 10.2196/59608.
Diabetic foot ulcers are common and costly. Most cases are preventable, although few interventions exist to reliably support patients in performing self-care. Emerging technologies are showing promise in this domain, although patient and health care provider perspectives are rarely incorporated into digital intervention designs.
This study explored patient and health care provider feedback on a smart sensing sock to detect shear strain and alert the wearer to change their behavior (ie, pause activity and check their feet) and considered how patient experience and attitudes toward self-care are likely to impact uptake and long-term effective engagement with the device to curate guiding principles for successful future intervention development.
This qualitative study combined semistructured interviews and a focus group alongside a participant advisory group that was consulted throughout the study. In total, 20 people with diabetic neuropathy (n=16, 80% with history of diabetic foot ulcers) and 2 carers were recruited directly from podiatry clinics as well as via a recruitment network and national health mobile app for one-to-one interviews either in person or via landline or video call. A total of 6 podiatrists were recruited via professional networks for 1 virtual focus group. Participants were asked about their experience of diabetic foot health and for feedback on the proposed device, including how it might work for them in daily life or clinical practice. The data were analyzed thematically.
Three main themes were generated, each raising a barrier to the use of the sock complemented by potential solutions: (1) patient buy-in-challenged by lack of awareness of risk and potentially addressed through using the device to collect and record evidence to enhance clinical messaging; (2) effective engagement-challenged by difficulties accepting and actioning information and requiring simple, specific, and supportive instructions in line with podiatrist advice; and (3) sustained use-challenged by difficulties coping, with the possibility to gain control through an early warning system.
While both patients and podiatrists were interested in the concept, it would need to be packaged as part of a wider health intervention to overcome barriers to uptake and longer-term effective engagement. This study recommends specific considerations for the framing of feedback messages and instructions as well as provision of support for health care providers to integrate the use of such smart devices into practice. The guiding principles generated by this study can orient future research and development of smart sensing devices for diabetic foot care to help optimize patient engagement and improve health outcomes.
糖尿病足溃疡很常见且成本高昂。大多数病例是可预防的，尽管几乎没有干预措施能可靠地支持患者进行自我护理。新兴技术在这一领域显示出前景，不过患者和医疗服务提供者的观点很少被纳入数字干预设计中。
本研究探讨了患者和医疗服务提供者对一种智能传感袜的反馈，该智能传感袜可检测剪切应变并提醒穿戴者改变行为（即暂停活动并检查双脚），并考虑了患者体验和对自我护理的态度可能如何影响对该设备的接受度以及长期有效使用，以制定未来成功干预开发的指导原则。
这项定性研究结合了半结构化访谈、焦点小组以及在整个研究过程中咨询的参与者咨询小组。总共直接从足病诊所以及通过招募网络和国家健康移动应用程序招募了20名糖尿病神经病变患者（n = 16，80%有糖尿病足溃疡病史）和2名护理人员，进行一对一的面对面访谈或通过固定电话或视频通话。通过专业网络招募了6名足病医生参加1次虚拟焦点小组。参与者被问及他们的糖尿病足部健康经历以及对该提议设备的反馈，包括该设备在日常生活或临床实践中对他们可能有怎样的作用。对数据进行了主题分析。
产生了三个主要主题，每个主题都提出了使用该袜子的障碍以及潜在的解决方案：（1）患者接受度——因对风险缺乏认识而受到挑战，可能通过使用该设备收集和记录证据以加强临床信息传递来解决；（2）有效参与——因难以接受和采取信息行动而受到挑战，需要符合足病医生建议的简单、具体且支持性的指导；（3）持续使用——因应对困难而受到挑战，有可能通过预警系统获得控制。
虽然患者和足病医生都对这个概念感兴趣，但它需要作为更广泛的健康干预的一部分进行包装，以克服接受障碍和长期有效参与的问题。本研究建议在反馈信息和指导的框架制定方面进行具体考虑，并为医疗服务提供者提供支持，以便将此类智能设备的使用纳入实践。本研究产生的指导原则可为未来糖尿病足护理智能传感设备的研发提供方向，以帮助优化患者参与度并改善健康结果。
