Footcare Intervention Delivered by Community Health Workers: A Modified Delphi Study.

Abstract

Studies have shown that community health workers (CHWs) can effectively deliver footcare interventions (FCIs) as part of diabetes self-management education programmes in high-resource countries. However, more evidence is needed on implementing FCI in low-resource countries and more detailed information about the core components of FCI provided by CHWs. This study aims to refine the core components of the footcare intervention to be delivered by CHWs (FIne-CHWs) for T2DM patients and to analyse Delphi panel members' opinions and perceptions regarding the core components of FIne-CHWs. Triangulation data from previous steps of data collection (scoping and mapping review combined with interview data) identified 42 statements representing the core components of FIne-CHWs. After two rounds of a Delphi exercise involving 22 panel members, experts in diabetes from all over Indonesia, a consensus agreement was reached on 41 out of 42 statements of the core components of FIne-CHWs. Free-text responses to the Delphi survey were analysed using thematic analysis. One overarching theme emerged: CHWs "are only volunteers." This then was discussed in three themes, namely CHWs deliver footcare education for all people with diabetes, remuneration and incentives, and flexibility of community FCI. This study determined the core components of FIne-CHWs and also identified that the position of CHWs within the Indonesian healthcare system could impact the implementation of the FIne-CHWs programme.