IDF21-0257 The Feasibility of a Social Media-based Diabetic Foot Ulcer Prevention Program during the COVID-19 Pandemic in Canada

Abstract

Background: Diabetic foot ulcer (DFU) is a costly complication associated with excessive disability and mortality. Due to the COVID-19 pandemic impact on the healthcare system, recent studies have anticipated an increased DFU incidence among people with diabetes (PWD). Therefore, continuous education and support are necessary to promote PWD adherence to foot self-care recommendations. However, available community and health facility-based DFU prevention programs for PWD are mostly face-to-face and restricted regarding access and its impact on sustaining foot self-care adherence. With the adaption of telehealth to improve healthcare access and support self-management, social media offers some benefits that healthcare professionals could explore to empower patients to prevent DFU, but evidence on its feasibility is limited. Aim: This study aims to determine the feasibility of social media as an alternative method to engage PWD in DFU prevention. Method: This feasibility study utilized a partially randomized preference trial design to explore PWD acceptance of a social media-based DFU prevention program and its efficacy on foot care adherence, self-efficacy, foot health status, and quality of life. The participants in the experimental group received self-management education and support via a private Facebook group platform alongside their routine health care. In contrast, the control received only routine health care. The study intervention was based on Social Cognitive theory with the education content adapted from the Wounds Canada Diabetes, Healthy Feet and You module. Two to three posts are scheduled daily in formats such as text, videos, photos, polls, and web links for three months. Data collection involves a validated questionnaire administered through QualtricsXM survey software at baseline, one, and three-month post-intervention with an interview. The data were analyzed using SPSS-27 and NVivo-12. The cut-off point for all study outcomes was > 70% except for the quality of life (50%). Results: A total of 32 participants were enrolled in the study (intervention [n=23] and control group [n=9]). The intervention implementation and data collection are still ongoing. The participants in the intervention and control group baseline characteristics were not statistically different. Most participants had a moderate to high DFU risk level, 62.5% and 28.1%, respectively. At baseline, 62.5% of the participants have poor adherence to foot self-management recommendations. Nineteen participants have completed the study (intervention [n=12] and control group [n=7]). The intervention acceptance mean-score was 83.08 ± 9.93 (range, 71 – 99%). The intervention led to significant improvement in participants' adherence to foot self-care recommendations (p=0.01). Participants accepted the intervention because it enhanced their awareness of DFU as a debilitating health condition. Also, the intervention resulted in a non-significant increase in participants' communication with healthcare professionals about foot problems, awareness of community resources, foot health status, and physical functioning. Discussion: Preliminary data revealed that social media is a feasible platform to engage PWD in DFU prevention. In addition, the intervention improved participants' foot self-care adherence, communication with healthcare professionals, community resources awareness, foot health status, and physical functioning. The overall study findings would inform recommendations for integrating social media into DFU prevention programs during and beyond the COVID-19 pandemic.