The practice, nature, and impact of nurse-led type 2 diabetic foot prevention services and educational programs in Sub-Saharan Africa: a scoping review

Abstract

Objective: The objective of this study is to assess the scope of existing practice,
nature, and impact of nurse-led type 2 diabetic foot prevention services and
educational programmes in Sub-Saharan Africa (SSA).

Introduction: Type 2 diabetes mellitus (T2DM) in SSA imposes a heavy burden
on current healthcare services. Complications such as foot ulcers can have a
significant impact on patient care and healthcare resources. It is imperative to
identify patients at risk of developing diabetic foot complications and empower
them with diabetes self-management education and support from specialised
foot clinics is crucial. However, the availability of such programmes and services
in SSA is limited.

Inclusion criteria: Studies of nurse-led diabetic foot prevention services and/or
educational programmes in low- or middle-income countries in SSA for adults
with T2DM, written in English, between August 2013 and March 2024 were
considered.

Methods: Following the standard Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) guidelines for conducting and reporting
scoping reviews, searches were conducted on four electronic databases (CINAHL,
ProQuest, MEDLINE, and Scopus) and Google Scholar. The titles and abstracts
were scrutinised. All eligible papers were retrieved and screened for full text.
Results: The review included ten studies (across 14 papers), all of which focused
on nurse-led diabetes self-management education (DSME) programmes in
SSA. There are no specific educational programmes or services led by nurses
that focus exclusively on diabetic foot prevention. The analysis highlighted
the components of successful nurse-led DSMEs that led to positive glycaemic
control and self-care behaviors, including the focus on behavior change and
the DSME should be co-produced with service users. The theoretical aspects
of the DSME include evidence-based, structured, interactive, culturally and
linguistically appropriate group-based activities. The DSME should be delivered
over a period of several weeks, and sessions should last between 1.5 and 2 h.
Barriers to delivery and participation include the rainy season, stockouts, time
and resources needed, and a DSME that meets diverse levels of literacy and
education.

Conclusion: There is a heightened need for nurse-led, co-produced, culturally
congruent, frugal, and sustainable education interventions or programmes.
There is also a need for diabetic foot screening and foot ulcer prevention
services that can operate sustainably alongside these educational interventions
through task-shifted, simple, and frugal initiatives.