The co-creation of Foot Selfie, a patient-centered mobile intervention to prevent diabetic foot ulcers

BACKGROUND: Diabetic foot ulcers (DFU) represent a major global burden, requiring more effective prevention strategies. Digital solutions have been proposed to improve DFU early-detection and reduce DFU burden, but user-centered solutions for low-and-middle income countries (LMIC) are lacking. The aim of this paper is to describe the process and lessons learned from the co-creation of (1) an intervention based on a mobile health (mHealth) app for early detection of pre-ulcerative lesions and prevention of DFU in people living with diabetes, and (2) the strategy to pilot test the intervention in rural and urban settings in Peru. METHODS: We conducted a co-creation process between December 2024 and April 2025. Four workshops were held in Lima (urban) and four in Piura (semi-rural), involving 54 people living with diabetes, their caregivers, and healthcare professionals (HCPs). In workshop #1, patient journey mapping was used to identify barriers and facilitators to DFU care. Workshops #2 and #3 focused on the co-development of a mHealth app, while workshop #4 gathered participant feedback on study procedures for the upcoming pilot study. RESULTS: A total of 23 people with diabetes, 21 HCPs, and 10 caregivers participated in the workshops. Patient journeys revealed barriers to DFU management, including health system fragmentation, limited clinician training, and insufficient education for people with diabetes and caregivers. In workshops #2 and #3 a beta version of the mHealth app was tested by the participants who proposed recommendations on how to improve it and other features to be added. Study procedures for the coming pilot study of the developed intervention were tested with role play. Participants recommended community-based recruitment of participants for the pilot study, manuals and videos to train users, family engagement, WhatsApp reminders, a helpline, interim feedback calls, and graphical results in multiple formats. Participant engagement was sustained throughout the study, with participants contributing from barrier identification through to intervention and procedure design. CONCLUSIONS: This work describes the usage of a structured co-creation processes to develop a digital health tool for DFU prevention and detection. The co-creation process was conducted with the aim to develop an intervention that is contextually relevant, acceptable, and more likely to be implemented successfully in the Peruvian context. The processes described here offer a practical model for developing DFU-prevention interventions in similar resource-constrained environments. The upcoming pilot study will be essential to evaluate usability, adherence, and early signals of impact, ultimately guiding future scale-up.