Developing a smart-sensing sock to prevent diabetic foot ulcers: a qualitative study

Background: diabetic foot ulcers are common and costly. Most cases are preventable, though few interventions exist to reliably support patients to perform self-care. Emerging technologies are showing promise in this domain, though patient and provider perspectives are rarely incorporated into digital intervention designs.<br/><br/>Objective: this study explores patient and provider feedback on a smart-sensing sock to detect shear strain and alert the wearer to change their behaviour (i.e. pause activity and check their feet); and considers how patient experience and attitudes to self-care are likely to impact uptake and long-term effective engagement with the device in order to curate guiding principles for successful future intervention development. <br/><br/>Methods: this qualitative study combined semi-structured interviews and a focus group alongside a participant advisory group that was consulted throughout the study. Twenty people with diabetic neuropathy (16 with history of diabetic foot ulcer) and two carers were recruited directly from podiatry clinics, as well as via a recruitment network and national health mobile application, for one-to-one interview either in-person, or by landline or video call. Six podiatrists were recruited via professional networks for one 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 analysed thematically.<br/><br/>Results: three main themes were generated each raising a barrier to use of the sock, complemented by potential solutions. 1. Patient buy-in: challenged by lack of awareness of risk, potentially addressed though using the device to collect and record evidence to enhance clinical messaging. 2. Effective engagement: challenged by difficulties accepting and actioning information, requiring simple, specific and supportive instructions in line with podiatrist advice. 3. Sustained use: challenged by difficulties coping, with the possibility to gain control with an early warning system. <br/><br/>Conclusions: 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. The study recommends specific considerations to the framing of feedback messages and instructions; as well as provision of support for healthcare providers to integrate the use of such smart devices into practice. Guiding principles generated by this study can guide future research and development of smart sensing devices for diabetic foot care, to help optimise patient engagement and improved health outcomes. <br/>