Empowering Foot Care Literacy Among People Living With Diabetes and Their Carers With an mHealth App: Protocol for a Feasibility Study

Huiling Liew, Anita Pienkowska, Chin-Siang Ang, Muhammad Daniel Azlan Mahadzir, Kelley Fann Ing Goh, Nandika Lodh, Iva Bojic, Ashwini Lawate, Qi Chwen Ong, Kavita Venkataraman, Josip Car, Andy Hau Yan Ho, Huiling Liew, Anita Pienkowska, Chin-Siang Ang, Muhammad Daniel Azlan Mahadzir, Kelley Fann Ing Goh, Nandika Lodh, Iva Bojic, Ashwini Lawate, Qi Chwen Ong, Kavita Venkataraman, Josip Car, Andy Hau Yan Ho

Abstract

Background: Diabetic foot ulcers (DFUs) cause significant morbidity affecting 19% to 34% of people living with diabetes mellitus. DFUs not only impair quality of life but may also result in limb loss and mortality. Patient education has been advocated to raise awareness of proper foot self-care and the necessity of seeking assistance when a foot wound occurs. Modern technologies, including mobile health (mHealth) interventions such as health apps, bring the potential for more cost-effective and scalable interventions.

Objective: This study aims to examine the feasibility and usability of a newly developed mHealth app called Well Feet, which is a diabetes and foot care education app for individuals at risk of developing DFU.

Methods: Well Feet was developed using an evidence-based and expert panel cocreation approach to deliver educational content available in 3 languages (ie, English, Chinese, and Malay) via animation videos and a range of additional features, including adaptive learning. A nonrandomized, single-arm feasibility study using a mixed methods approach with a series of validated questionnaires and focus group discussions will be conducted. In total, 40 patients and carers will be recruited from a tertiary hospital diabetes clinic to receive a 1-month mHealth intervention. The primary outcomes are the usability of the app and a qualitative perspective on user experience. Secondary outcomes include changes in foot care knowledge, self-management behaviors, and quality of life.

Results: Patient recruitment began in July 2023, and the intervention and data collection will be completed by the end of September 2023. This study has been approved by National Healthcare Group Domain Specific Review Board (2022/00614) on February 10, 2023. The expected results will be published in spring 2024.

Conclusions: Through this feasibility study, the Well Feet DFU education app will undergo a comprehensive quantitative and qualitative evaluation of its usability and acceptance for future improvement in its design. With local contextualization, cultural adaptation, and its multilingual functionality, the app addresses a critical aspect of DFU health education and self-management in a multiethnic population. Findings from this study will refine and enhance the features of the app based on user feedback and shape the procedural framework for a subsequent randomized controlled trial to assess the effectiveness of Well Feet.

Trial registration: ClinicalTrials.gov NCT05564728; https://ichgcp.net/clinical-trials-registry/NCT05564728.

International registered report identifier (irrid): DERR1-10.2196/52036.

Keywords: diabetes foot ulcer; diabetes mellitus; digital therapeutics; feasibility study; mHealth; mobile phone.

Conflict of interest statement

Conflicts of Interest: None declared.

©Huiling Liew, Anita Pienkowska, Chin-Siang Ang, Muhammad Daniel Azlan Mahadzir, Kelley Fann Ing Goh, Nandika Lodh, Iva Bojic, Ashwini Lawate, Qi Chwen Ong, Kavita Venkataraman, Josip Car, Andy Hau Yan Ho. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 21.11.2023.

Figures

Figure 1
Figure 1
Selected screenshots from the Well Feet app.
Figure 2
Figure 2
Participant flow through this study (CONSORT [Consolidated Standards of Reporting Trials]).

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