Podiatrists understand that diabetes-related foot disease (DRFD) is a major global health issue, responsible for the highest rates of diabetes-related hospitalisations and lower limb amputations. In Australia, over 5,000 lower limb amputations are performed annually due to complications from diabetes, and the mortality rates associated with DRFD are comparable to those of several cancers.
A virtual reality (VR) training package was developed and distributed to several Aboriginal Community Controlled Health Organisations (ACCHOs) across South Australia, to specifically address DRFD in Aboriginal and Torres Strait Islander people. The success of the VR training has had a measurable impact on the delivery of care within the Multi-disciplinary Telehealth Foot Service.
This initiative has far-reaching potential, offering a blueprint for health services across Australia.
The work described in this article occurs on the traditional lands of Aboriginal communities in South Australia and beyond. The author and the partner organisations involved in this work would like to acknowledge and celebrate that Aboriginal and Torres Strait Islander people are the Traditional Custodians of the land, known as Australia. We recognise that Aboriginal and Torres Strait Islander people are the First Peoples of Australia and that within these two distinct cultural groups, there is great cultural diversity. We pay our respects to Aboriginal people, Elders, past and present, their continuing connection to this land and thriving cultural practices and knowledge.
Aboriginal and Torres Strait Islander people are disproportionately affected by DRFD; facing higher rates of diabetes, hospitalisation, amputation, and mortality than non-Indigenous Australians.
These health outcome disparities need to be understood in the context of historical, social, and cultural factors as colonisation and racism has a direct effect on the health outcomes of Aboriginal and Torres Strait Islander people. Those living in rural and remote regions experience even greater disparities in health outcomes, with limited access to specialist care.
A key strategy in reducing the risk of amputation is multidisciplinary care, which has been shown to decrease amputation rates by between 40 to 60%. However, these specialised clinics — which require expertise from podiatry, vascular surgery, infectious diseases, and endocrinology — are largely concentrated in metropolitan areas.
In South Australia, such services are largely unavailable in rural and remote areas. To address this, the Royal Adelaide Hospital launched a Multi-disciplinary Telehealth Foot Service in 2020, extending these vital services to patients in regional and remote locations. The success of this service relies heavily on the capacity and expertise of local clinicians, many of whom lack specific training in the complex assessment and management of DRFD.
In response, a virtual reality (VR) training package was developed and distributed to several Aboriginal Community Controlled Health Organisations (ACCHOs) across South Australia.
The training was designed to bridge the gap in DRFD-related knowledge by providing culturally appropriate, immersive education in the assessment and triage of foot complications associated with diabetes. The VR package consists of five patient modules, each designed to equip clinicians with the skills necessary for conducting foot assessments and determining risk status in a culturally safe manner.
This collaborative initiative involved both Aboriginal and non-Indigenous clinicians and researchers from Central Adelaide Local Health Network, the South Australian Health and Medical Research Institute (SAHMRI) Wardliparingga Aboriginal Health Equity, the University of Adelaide and the University of South Australia.
Funding was provided through a Commonwealth Indigenous Australians’ Health Programme grant, aimed to empower healthcare workers in these communities to manage DRFD with greater confidence and competence.
An Aboriginal led feasibility method was undertaken with a total of 29 health practitioners from South Australian ACCHOs who participated in the training, and their feedback was overwhelmingly positive.
Confidence scores collected before and after the training demonstrated significant improvements in participants’ ability to perform essential assessments, such as palpating foot pulses, conducting monofilament tests to assess for peripheral neuropathy, identifying foot ulcers, and determining a patient’s risk for complications.
Clinicians reported that the VR training was highly usable, engaging, and relevant to their everyday practice, with many indicating that they would recommend the program to colleagues. Importantly, practitioners also noted that the training had significantly expanded their knowledge and that they felt more equipped to manage DRFD independently and with greater efficacy.
The success of the VR training has had a measurable impact on the delivery of care within the Multi-disciplinary Telehealth Foot Service.
With local clinicians better trained in assessing and triaging DRFD, the service has become more efficient, with practitioners able to manage more cases closer to home, thus reducing the need for patients to travel long distances to metropolitan hospitals. This has not only improved the timeliness of care but also enhanced the overall quality of diabetes-related foot management in rural and remote communities.
The positive reception of this initiative highlights the potential of VR-based training as a valuable tool in strengthening the capacity of local health systems to manage complex conditions like DRFD; particularly in underserved populations.
The culturally tailored nature of the training, combined with the adaptability of virtual reality technology, has proven effective in addressing the training gap among rural and remote healthcare providers.
This model could be extended to other regions, offering a potential blueprint for future efforts to reduce health disparities, particularly within Indigenous communities. This enhances the efficiency and effectiveness of the Telehealth Foot Service, with more skilled and confident practitioners now better equipped to deliver care to patients in their local communities.
The VR training was also made available to remote and very remote Aboriginal Community-Controlled Health Organisations in the Northern Territory and the Kimberley region of Western Australia. This complements the implementation of workforce training and local services, funded through the Aboriginal and Torres Strait Islander Diabetes-Related Foot Complications Program.
The training was well received. Early indications suggest that, if appropriately funded and embedded into local services, culturally appropriate virtual reality technology can play an important role in strengthening the capacity of primary health care workforce and addressing the disparities associated with DRFD in Aboriginal and Torres Strait Islander communities nation-wide.
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This work is part of the Aboriginal and Torres Strait Islander Diabetes-Related Foot Complications Program, which receives grant funding from the Australian Government. |
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