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Impact of Foot Screening Programmes on Early Detection of Foot Problems among Older Adults in Nigeria

Abstract

Foot problems are an important public health concern among older adults because age-related changes, chronic diseases, reduced mobility, poor circulation, sensory impairment, skin changes, and inadequate foot care may increase the risk of foot ulcers, infections, deformities, pain, and other conditions that can affect mobility and quality of life. Older adults with diabetes and other chronic health conditions may be particularly vulnerable to foot complications and may require regular assessment for early identification of abnormalities. However, foot problems may remain undetected because routine foot screening is not consistently available, awareness of foot health is limited, and some older adults may seek healthcare only after symptoms become severe. Foot screening programmes provide an opportunity for systematic assessment of foot health and early identification of abnormalities requiring further evaluation or intervention. Against this background, this study investigates the impact of foot screening programmes on early detection of foot problems among older adults in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Systems Framework. The Health Belief Model explains how older adults' perceptions of susceptibility to foot problems, perceived severity, perceived benefits of regular foot screening, perceived barriers, and cues to action may influence participation in screening and subsequent healthcare-seeking. The Social Ecological Model emphasizes the influence of individual, family, community, healthcare, and environmental factors on access to foot screening and preventive services. The Health Systems Framework highlights the importance of service delivery, healthcare workforce, health information, medical equipment and technologies, financing, accessibility, referral systems, and continuity of care in effective foot screening programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how foot screening programmes may influence early detection of foot problems among older adults in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise adults aged 60 years and above residing in selected urban, semi-urban, and rural communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, healthcare facilities, and eligible older adults. Foot screening programmes will be assessed using indicators such as availability and accessibility of screening services, screening frequency, trained healthcare personnel, screening equipment, foot examination procedures, assessment of skin and nails, evaluation of foot structure and deformities, assessment of circulation and sensation, identification of risk factors, health education, referral arrangements, and follow-up services. Early detection of foot problems will be assessed using indicators such as newly identified foot ulcers, skin abnormalities, fungal or other suspected infections, nail disorders, calluses and corns, deformities, impaired sensation, circulation-related abnormalities, pressure points, wounds, foot pain, and other clinically relevant abnormalities requiring further assessment. Data will be collected using structured questionnaires, standardized foot-screening forms, clinical examination records, screening registers, healthcare facility records, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, health conditions, foot-screening coverage, screening findings, and patterns of foot problems. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of foot screening programmes on early detection of foot problems. Where a quasi-experimental design is adopted, detection rates before and after implementation of foot screening activities may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that foot screening programmes have a significant positive impact on the early detection of foot problems among older adults in Nigeria. Older adults who participate in regular foot screening are expected to have a greater likelihood of previously undetected foot abnormalities being identified than those without access to routine screening. Systematic screening may facilitate early identification of ulcers, infections, skin and nail disorders, deformities, sensory abnormalities, circulation problems, and other conditions requiring medical attention. Early detection may provide opportunities for timely treatment, referral, preventive foot-care education, appropriate footwear recommendations, monitoring, and management of underlying health conditions. Community-based screening may also reduce geographical and financial barriers to preventive healthcare and improve awareness of foot health among older adults and their caregivers. However, limited availability of trained healthcare personnel, inadequate screening equipment, financial barriers, poor referral and follow-up systems, limited awareness, mobility difficulties, and inadequate access to healthcare facilities may reduce the effectiveness of foot screening programmes. The study therefore expects accessible, regular, properly conducted, and well-integrated foot screening programmes to contribute significantly to improved early detection and management of foot problems among older adults in Nigeria. The study is expected to contribute to the literature on foot health, geriatric health, foot screening, chronic disease prevention, diabetes-related foot complications, community health, preventive healthcare, health education, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, hospitals, healthcare professionals, community health workers, geriatric-care providers, diabetes-care programmes, development partners, and policymakers regarding strategies for improving foot health among older adults. The study will also provide evidence-based recommendations for expanding community and facility-based foot screening programmes, integrating routine foot assessment into primary healthcare and chronic disease services, improving access to trained healthcare personnel and screening equipment, strengthening referral and follow-up systems, increasing awareness of foot-care practices among older adults and caregivers, and promoting early healthcare-seeking for suspected foot problems across Nigeria.

Keywords: Foot screening programmes, early detection, foot problems, older adults, foot health, diabetic foot complications, preventive healthcare, geriatric health, community health, health screening, Nigeria, public health.