International journal of nursing studies · 2026
Diabetic foot screening programs through an implementation science lens: A rapid review.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
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Fakhfakh Maya, Andoulsi Yassin, Brousseau-Foley Magali, Pallin Jennifer A, Buckley Claire M, Drudi Laura M, de Mestral Charles, Kuhnke Janet L, McIntosh Caroline, Blanchette Virginie
Аннотация
BACKGROUND: Diabetes-related foot conditions drive amputations and premature mortality worldwide. Although international guidelines recommend annual foot screening based on risk, implementation remains insufficient and inequitable. This rapid review synthesized evidence on primary-care diabetic foot screening programs, examined barriers and facilitators using the Consolidated Framework for Implementation Research, and mapped strategies with an equity lens.
METHODS: A rapid review following Dobbins (2017) was reported according to PRISMA guidelines. MEDLINE, EMBASE, and CINAHL were searched from inception to October 2025, supplemented by citation tracking. Data extraction focused on study and participant characteristics, program components, PROGRESS+ equity factors, and Consolidated Framework for Implementation Research determinants. Narrative synthesis included descriptive overview of program components and Consolidated Framework for Implementation Research-based analysis of barriers, facilitators, and strategies mapped to Expert Recommendations for Implementing Change.
RESULTS: 44 studies from 16 countries were included, most (73%) from high-income settings with contributions from upper-middle-income (11%) and low- and middle-income countries (16%). Programs frequently integrated screening into routine workflows, incorporated risk stratification, and were delivered by multidisciplinary teams. Facilitators included validated guidelines, electronic health records templates and prompts, cultural and linguistic adaptation, leadership commitment, and coalition-building. Barriers included resource constraints, staff turnover, fragmented care, and economic barriers to access. Expert Recommendations for Implementing Change reported strategies included cyclical small tests of change, audit and feedback, educational meetings and materials, coalition-building and infrastructure changes. Equity tailoring was described but inconsistently applied, with no study systematically stratifying outcomes by sociodemographic subgroups.
CONCLUSION: Diabetic foot screening programs share common components but face barriers to equity and sustainability. Implementation informed by Consolidated Framework for Implementation Research analysis and grounded in equity can reduce avoidable amputations globally.
PROTOCOL PUBLICATION: The protocol was published in HRB Open Research (doi:10.12688/hrbopenres.14119.1).
METHODS: A rapid review following Dobbins (2017) was reported according to PRISMA guidelines. MEDLINE, EMBASE, and CINAHL were searched from inception to October 2025, supplemented by citation tracking. Data extraction focused on study and participant characteristics, program components, PROGRESS+ equity factors, and Consolidated Framework for Implementation Research determinants. Narrative synthesis included descriptive overview of program components and Consolidated Framework for Implementation Research-based analysis of barriers, facilitators, and strategies mapped to Expert Recommendations for Implementing Change.
RESULTS: 44 studies from 16 countries were included, most (73%) from high-income settings with contributions from upper-middle-income (11%) and low- and middle-income countries (16%). Programs frequently integrated screening into routine workflows, incorporated risk stratification, and were delivered by multidisciplinary teams. Facilitators included validated guidelines, electronic health records templates and prompts, cultural and linguistic adaptation, leadership commitment, and coalition-building. Barriers included resource constraints, staff turnover, fragmented care, and economic barriers to access. Expert Recommendations for Implementing Change reported strategies included cyclical small tests of change, audit and feedback, educational meetings and materials, coalition-building and infrastructure changes. Equity tailoring was described but inconsistently applied, with no study systematically stratifying outcomes by sociodemographic subgroups.
CONCLUSION: Diabetic foot screening programs share common components but face barriers to equity and sustainability. Implementation informed by Consolidated Framework for Implementation Research analysis and grounded in equity can reduce avoidable amputations globally.
PROTOCOL PUBLICATION: The protocol was published in HRB Open Research (doi:10.12688/hrbopenres.14119.1).