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Table 1 Included reports

From: Where do we stand? The availability and efficacy of diabetes related foot health programs for Aboriginal and Torres Strait Islander Australians: a systematic review

Author, program & location Program type Program description & staffing Reported outcomes Culturally safe aspects
Bandaranaike, 2010 [30]
Stamping out diabetic foot in the Pilbara, Western Australia
Pilbara, WA
Conduct & assess training program Staff training in IDFP at Port Hedland Hospital Dialysis unit and four Western Desert communities in March–April 2009.
Diabetes clients were provided with equipment and taught self-management practices by the program coordinator and staff who attended the workshop.
Aims were to: (1) evaluate how the IDFP can be adapted for use in the Pilbara; and (2) evaluate the impact of the program in Aboriginal populations by assessing knowledge and self-management practices pre and post implementation.
Program was implemented by a physiotherapist, podiatry student and diabetes educator.
Workshop activities and practical applications rated highly by attendees.
Knowledge scores improved post course.
Completed DART forms had good inter-rater reliability with podiatrist.
Clients reported better access to podiatry services, delivered in a culturally appropriate manner.
Clients did not use all of the equipment provided (thongs, soap, mats).
Focus on working within the communities needs and building relationships.
Ballestas 2014 [27]
Moorditj Djena (Strong Feet)
Perth WA
Service delivery & education Aboriginal podiatry outreach program.
Aim: to identify, manage and prevent foot complications from chronic disease and to improve diabetes self-management.
Implemented in 2011 in conjunction with the local Aboriginal community, the Perth Aboriginal Medical Service, and the WA Department of Health.
Fixed clinic locations include community centres, an Aboriginal health service, Medicare Locals, a hospital, a health unit office, and a mobile podiatry van.
Referrals from GPs, hospitals, community health centres, word of mouth, self and community referrals
Staff consists of a coordinator, podiatrists, diabetes educator, AHW.
Attended by 702 clients (by 2013).
14.5% of Aboriginal and Torres Strait Islander adults in region had attended.
3500 occasions of service.
High community regard reported.
Clinical outcomes evaluation underway with hospital data linkage pre & post enrolment in program.
Community collaboration.
Aboriginal staff.
Cultural awareness training.
Accessible clinics & transport arrangements.
Blatchford 2015 [28]
Albury Wodonga Aboriginal Health Service
Service delivery Podiatry services implemented in an Aboriginal Health service in 2011. Clients had Texas Diabetic Foot Risk evaluation, and incidence of new foot complications recorded.
Retrospective audit of clients with Type 2 diabetes for 26 months (n = 70).
Aim was to identify client’s foot risk status and determine if review appointments met national evidence based timeframe guidelines.
70% attendance at appointments.
94% meet national guidelines for foot assessments.
Drop in appointments.
Transport provided.
Cherbourg Regional Aboriginal and Islander Community Controlled Health Service. Outreach Magazine. [20]
Service delivery & education Initiation of fly-in podiatry service 20 times/year at ACCHS.
Number of Annual Diabetes Neurovascular Foot Assessment.
Works with local GP for referrals to vascular, renal or neurological specialists, dietitian, diabetes educator or exercise physiologist.
Part of medical students training program.
Reports of lower number of clients requiring treatment of diabetic foot and leg ulcers or amputation dressings.
Decrease in number of acute problems.
80 clients consistently attend annual assessment.
Good community support.
Connors 2008 [29]
Who stops the footrot? Interviews with Aboriginal health workers trained in IDFP
Regional and remote Qld communities
Assess program Protocol paper describing two day IDFP workshop followed by telephone questionnaires and evaluation of DART forms.
Aim is to determine if the IDFP is an effective method of teaching AHWs how to screen diabetic clients for foot problems and referral onto other health professionals.
15 AHWs participated in the program.
Nil reported to date IDFP developed for Indigenous clients and staff.
Coombes 2015 [21, 33]
A Roving podiatrist
North East & West of Alice Springs, NT
Service delivery and education Development & evaluation of outreach podiatry services for 26 weeks a year, based on the IDFP, in 14 NT communities since 2009.
Aim is to maximise availability of podiatry services and upskilling of clinic staff to manage foot problems between podiatrist visits.
Services provided by podiatrist and Indigenous podiatry assistant.
Number of clients increased by 167%.
Annual foot check percentages increased to 70–90% of community.
Increased community engagement. Increased use of protective footwear.
Using IDFP.
Male/female team.
Indigenous assistant.
Emphasis on relationship with communities.
Radowski, 2011 [31]
Implementing the Indigenous Diabetic Foot Project in the lower gulf of Australia
Rural and remote
north-west Qld
Assess training program A Two-day workshop to train seven AHWs in using the IDFP.
Aim is for AHWs to pre-screen diabetic feet, recognise ulcer risk and recognise foot problems that require medical attention or treatment by a podiatrist.
All participants could complete the screening techniques.
DART forms now used in assessment of diabetes clients.
Using IDFP.
Schoen 2010 [25]
Health promotion resources for Aboriginal people
Perth & rural towns, WA
Assess program A series of six focus group discussions in March–May 2008 with 60 Aboriginal people including Elders, AHWs, community members, and Aboriginal students.
Sites included an Elders club in Perth, two rural townships and the Aboriginal Health Training College in Perth.
Aim was to determine what materials, medium and foot care messages are preferred by comparison of items produced by IDFP, Healthy Living NT and Derbarl Yerrigan Health Service.
Unanimous support for the IDFP paper-based diabetes foot care education booklet and posters. Aboriginal reference group provided guidance for the project.
Aboriginal and non-Aboriginal interviewer. Reciprocity involving
an exchange between the researchers and the participants.
Schoen 2016 [23]
Diabetes foot care education movies for Aboriginal people: Bran nue leg & Deadly
Kimberley, WA
Develop education program Documented production of two movies available online or as DVDs. Aim is to improve health literacy and encourage clinic attendance.
Bran nue leg aimed at people at risk of developing diabetes. Deadly (and not in a good way) is aimed at people living with an amputation.
Part of a High Risk foot intervention program.
Initial release so no reported outcomes. Produced with Goolarri Media Enterprises and local community members.
Townsend, 2012 [32]
Evaluation of the NSW Indigenous Diabetic Foot Program for health workers
Lower Mid North Coast, NSW
Assess training program One day IDFP workshop for 11 AHWs with pre, post & 6 month post workshop knowledge questionnaire.
Aim was to evaluate the effectiveness of the IDFP by testing AHWs perceptions of the education workshop and integration of the screening tools into clinical practice.
Increase in referrals to podiatrist & knowledge scores post workshop.
55% implemented DART form but no patient workshops run.
Occasions of service increased from 7 to 11%.
Using IDFP.
Turner 2006 [22]
Podiatry Outreach, Yirrkala Health Centre
East Arnhem Land, NT
Service delivery and education Single day visiting podiatry outreach clinic in April 2005.
Aim was to bring a number of health professionals from outside the clinic to address the numerous aspects of diabetes.
Presentation on the day provided to clinic staff regarding diabetes foot health, treatment protocols and client education.
Staff present included a podiatrist, diabetes educator (for AHWs and clinic staff), nutritionist and nurse.
Screening, risk assessment and education provided to Aboriginal community members with diabetes
Collation of diabetes clients onto chronic disease register.
Increased awareness of diabetes in the community (not quantifiably measured).
At Aboriginal Health centre.
AHWs performing screening
Transport to clinic arranged.
Warnock 2004 [24, 35]
Indigenous Diabetic Foot Program (IDFP)
Palm Island, North Qld
Develop program Education programs for both AHW and Aboriginal clients with diabetes.
Educational card set, videos.
Health promotion media and slogans.
Components of program include learning: (i) how to care for feet, (ii) how to check feet, (iii) finding pulses on the foot, (iv) using a monofilament (v) understanding the difference between high risk and low risk feet, (vi) how to teach clients the basics of self-care, (vii) completing a DART form, (viii) referral process for a high risk foot.
* details combined from a number of sources including presentations and published reports
AHWs more confident in providing education and screening.
Increase in AHW knowledge levels up to 6 months post course.
Increased referrals from AHWs to podiatrists.
Presented to local focus groups
Watson 2001 [26]
Diabetic foot care: developing culturally appropriate educational tools
Darwin, East Arnhem,
Katherine, NT
Develop education tools Series of focus groups, telephone calls and mail-outs to help develop a culturally sensitive visual educational tool on foot care for people with diabetes.
Attendees included nurses, GPs, AHWs, cross cultural liaison officers and Indigenous Australians with diabetes.
Aim is to develop a tool that provides information on control of diabetes, prevention of foot complications and encouragement to seek advice early.
Decision to develop a picture based flip chart.
Nil reported to date
In collaboration with Indigenous Australians and health professionals.
  1. WA Western Australia, GP General Practitioner, NSW New South Wales, ACHHS Aboriginal Community Controlled Health Services, % percentage, QLD Queensland, DVD digital video disc, NT Northern Territory, AHW Aboriginal Health Workers, IDFP Indigenous Diabetic Foot Program, DART Diabetic foot Assessment of Risk Test form