# ‘Diabetes Makes You Lose Your Leg’: Footcare Self‐Management Amongst I‐Taukei Fijians—A Wearable Camera Study

## TL;DR

This study explores how I-Taukei Fijians manage diabetes-related footcare, revealing challenges like limited resources and the impact of foot complications on employment.

## Contribution

The study introduces a novel wearable camera method to observe real-time footcare behaviors among I-Taukei Fijians with diabetes.

## Key findings

- Most participants performed basic footcare like checking for cuts, but lacked comprehensive practices.
- Foot complications like amputations led to job loss and highlighted barriers like poor healthcare access and resources.
- Family and community support were key facilitators of footcare self-management.

## Abstract

Footcare is an integral part of diabetes self‐management, yet there is limited research on diabetes footcare self‐management. This paper explores footcare self‐management and the impact of diabetes foot complications amongst I‐Taukei Fijians in Fiji.

This mixed‐method research examines data from the innovative Fijian Diabetes Cam study, consisting of photographic images, photo‐elicitation interviews, and researcher observation. A strategic sample of 30 I‐Taukei Fijian adults with diabetes participated. Participants wore a camera that photographed their activities, behaviour, and environment every 7 s for 4 days. Images were used in semi‐structured photo‐elicitation interviews at home, with the images as prompts. Image data and observation were descriptively analysed, while photo‐elicitation responses were thematically analysed.

While all participants said they performed footcare, for most this was limited to looking for cuts and wounds. Those with foot complications such as amputations have to leave employment. Facilitators included family and community support. Key barriers included the lack of preventive health services and support; poor resourcing and accessibility of dressing supplies, blood sugar testing kits and mobility aids and the warm climate hindering the wearing of closed shoes. Access to appropriate housing and transportation were also key barriers for those with amputations.

This study suggests that I‐Taukei patients recognise the need for footcare self‐management and are largely motivated to do it. However, there is a lack of health education and the health service lacks the resources and trained staff to meet the needs of the people. The underfunded and under‐resourced health system is a major contributor. Nevertheless, there are opportunities to improve health promotion actions.

Health promotion approach to diabetes footcare self‐management in Fiji could significantly improve the lives of people living with diabetes and reduce the risk of complications and amputation. Donor countries and WHO need to consider the support provided to assist Fiji to manage this increasingly challenging public health issue.