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Table 4 Podiatrist focus group results

From: Factors influencing Australian podiatrists’ behavioural intentions to adopt a smart insole into clinical practice: a mixed methods study

Focus Group ThemeParticipant Quote
Performance Expectancy
“What’s the evidence?”“I would be open to learning about (a smart insole) if I'm confident and if I've seen the (efficacy) data.” P1a
“I want to see the evidence behind something that I am giving my patients.” P3b
“…what's the evidence? What's the benefit to our patients and us as clinicians of incorporating this software? Does it outweigh good diabetic foot education, good footwear education?” P7b
reliability: “I just want it to work!”“I don't want to have to trouble shoot with the device. I want it to just work!” P3b
“...it is my reputation…”“Well if I am using them...it is my reputation...as a clinician (if the device doesn’t perform as expected)...” P1a
Social Influence
“…because another patient is going to tell another patient…”“If…we had a patient who was willing to tell us about how he used it and how he found it…so we got it from a patient's perspective and then we can say "well actually that's quite good, let’s try it"...You get the patient, then we can get them to talk to...other patients...” P1a
“a small portion of my clients would be appropriate. And maybe that might have an impact on giving other people the opportunity to witness this and witness the benefits which might…even things up for people who…get written off for things because they're deemed inappropriate from the beginning.” P8b
“I don't sell anything that I haven’t tried or looked at, or you know someone's recommended...” P1a
Facilitating Conditions –patient centred
“…footwear…is going to be a challenge…”“…with the variation of footwear we do see… trying to get people to change their footwear, to be able to modify the insole to fit the very wide range of shoes…is going to be a challenge.” P4a
“I find that a lot of my clients...mobilise in slippers, no shoes at all and in general wear their good shoes down the street and then come home and they won't be in footwear again for the rest of the day.” P2a
“…some patients (present to clinic)...completely bare foot.” P4b
“…(a) sock would be preferable to an in-shoe device, and I think that would be particularly pertinent to the private sector where people have to choose between purchasing either multiple devices or being dedicated enough to ensure they have got it on all day.” P3b
cost: “…biggest barrier is going to be cost”“...we were wondering about what the cost might be?” P3b
“I think the biggest barrier is going to be cost” P3a
“Cost as well… the towns I service through the public system are very low socioeconomic where they do struggle just to afford a $15 consult fee…I don't think it (smart insole) would be...an option.” P4a
age: “...your older aged people…would probably find it harder to adapt and learn.”“…people in…the younger age bracket will be more inclined…to use the technology as opposed to your quite older aged people, who would probably find it harder to adapt and learn.” P4a
“But you've got a lot of people set in their ways who will not try no matter what. So I think, especially...the older ones or…the lower social economic people...I think using (a smart insole) would be quite hard for those people.” P1a
“ You're going to have to direct it to young, middle aged who are going to be tech savvy, who are going to have the watches…. Because anything more complicated you're not going to engage with them, especially the elderly.” P2a
“A general rule of thumb would be that younger people are more tech savvy and more willing to try and adopt it. In my experience.” P3b
“…for me, I would base it (recommending a smart insole) on compliance (rather) than age or anything.” P3a
“...you're gonna have to be selective because those people (not appropriate for insole usage)… not necessarily are elderly. You get a lot of middle aged people who can't get down to their feet...” P4a
geographical and cultural barriers: “I don't think in Darwin it would work at all!”” I don't think in Darwin it (smart insoles) would work at all!” P1b
“...it’s probably not suitable in an NT indigenous setting due to many barriers including…the fact that many people don't wear shoes or any footwear. Technology is probably something that's.. not really appropriate. People are quite transient, they tend to move around a lot.” P1b
“ So technology, I mean we're talking about a population base (remote indigenous Australians) that doesn't have mobile phones.” P1b
And technology itself...the availability and all those things - user access to the technology (to phones, mobile reception electricity)...” P5b
language and culture: “...people may not understand…”“...people may not understand what they're agreeing to, or the requirements that might be involved in that due to the language barrier and may unwittingly agree to something that they don't fully understand..” P1b
Facilitating Conditions – podiatrist centred
cost: “...time is money...”“...obviously time is money in private. I think in the hospital it wouldn't be an issue, but in private you might have to come up with some solutions to cutting into their time.” P3a
“getting an item number (for MBS billing for private practice) is gonna be hard as well.” P1a
“…I'm at capacity already, and this would be another thing that I would need to do...to have time (to) investigate it further, to gain knowledge, and then implement it…would be difficult.” P8b
“Can it be used in off-loading?”“Can it be used in off-loading shoes as well as regular shoes?” P7b
“..could be used in any off-loading devices such as the CAM boots and Darco shoes with the padding?” P6b
Target Populations
secondary prevention:“I think in my current setting in the high-risk sector it would be most appropriate for people who have had healed wounds.” P6b
“I think you'd probably be looking if you get somebody in the 40's or 50's who have diabetic ulcers that'd probably be willing to try...” P1a
“…those younger people who have had diabetic foot ulcers, that it's had a large impact on their lives. It’s impacted their work, their family life, their social lives and I think they're the ones who'd be very motivated to use this technology because their wounds had such a huge impact on who they are and what they're about.” P3b
other target populations:“...for Charcot transition - so for people who have consolidated their Charcot foot and are returning to weight bearing it would be useful.” P7b
”I think…the worried well would probably be the best market for this (with) high levels of education.” P6b
  1. Identifier convention: ‘P’ refers to participant, the numeral denotes the order in which each participant first spoke during the focus group, ‘a’ denotes the regional Victorian focus group and ‘b’ denotes the focus group conducted at a national conference