Description of studies and their characteristics

Following a search of the databases, 622 citations were identified with a further 27 yielded from additional sources. Duplicates resulted in 54 citations being removed leaving 595 from which a further 119 were excluded following review of the title and abstract. Searches were concluded by 1.3.21. Upon full text reading a further 89 papers were removed and a further 12 removed upon critical review by authors, KA, PH and SA leaving 18 papers included in the scoping review (Fig. 1). The primary reasons for excluding studies at the full-text reviewing stage were: conference abstracts only available, no intervention, not related to person-centred care or did not meet the standards of proficiency set by the HCPC [11]. Table 1 displays the characteristics of the studies included in this review. However, information, such as age or gender are missing. The missing data was either not reported by the study or not applicable.

Table 1 Study traits/mappingGeographical distribution of studies

Geographical distribution represents countries where data were collected for each study (Fig. 2). Of the 18 studies, 11% were multi-sites. Australia [15, 18, 21, 26,27,28] contributed 33% of the papers and the United Kingdom 22%, representing 55% of the research undertaken in the area of person-centred care.

Fig. 2

Geographical distribution of studies

Setting/context

A variety of settings were represented with 41% at multiple sites [4, 16, 21, 26, 27, 29, 30]. Community settings accounted for 27% [15, 17,18,19, 28] with a further 6% in the home [25], and 16% at podiatry clinics or medical centres [23, 24, 31]. Eleven percent of the studies did not state the context or setting of the study [28, 29].

Study aims

Diabetes was the main focus of 72% of the studies reviewed [15, 16, 18,19,20, 23,24,25, 27, 29, 30], with 6% focusing on patients with PVD [5], 6% on patient with chronic disease [28] and 12% on those with visual impairment [24, 25]. None of the studies specifically used the term person-centred care (or a similar term) within their aims. There was, however, reference to ‘foot self-care and self-exam’ by one study [30], but these terms were not defined. ‘Foot examination’ using touch and smell alongside usual care was clearly outlined by one study [25]. The aims relating to diabetes varied from reducing amputation rates 6% [16], prevention, or early identification, of ulceration at 22% [20, 24, 29, 30]. One study looked at the prevention of falls in an older population with disabling foot pain (6%). Comparison of effectiveness of different education methods in relation to changes in foot health behaviours and attitudes was considered by one study (6%). Two studies (11%) focused specifically on Aboriginal and Torres Strait Island people. Chuter et al. [27] undertook a systematic review to consider ‘programmes’ which had successful outcomes in terms of foot related complications due to diabetes and Hu et al. [28] considered the differences between those who undertook a programme designed to support better chronic disease management and those who did not. Four studies (22%) undertook a service or pathway development approach [4, 17, 19, 26] in relation to how the service was operationalised [17, 19, 26], the feasibility of an integrated service [4] and cost-effectiveness and service improvement benefiting patients and clinicians [17].

Intervention focus

The scoping review considered who the person-centred care intervention was aimed at, which was categorised as ‘person/carer’ (56%) [15, 18, 20, 21, 23,24,25, 29,30,31], ‘practitioner’ zero studies, and ‘service’ one study [19]. The remaining studies combined ‘person/carer’ and ‘practitioner’ (6%) [22], ‘person/carer’ and ‘service’ (17%) [4, 17, 26] or all three categories (17%) [16, 27, 28].

Intervention types employed

The data extracted was analysed using descriptive qualitative analysis [32, 33] and initially coded by author, SA. Emergent categories were noted and subsequently checked for coherence by the authors, KA and SA (Table 2) leading to three overarching categories.

Table 2 Frequency table of the interventions utilisedCategory 1: service facilitated person-centred care

This theme describes a concept where an intervention made a structural change to service delivery for the purposes of person-centred care and has three sub-themes. The sub-theme ‘referral pathways to access assessment/care’ describes increased access to a range of services for patients with diabetes [16] and improvements for access to podiatry services via self-referral [17]. The sub-theme ‘multidisciplinary approaches’ describes changes to care delivery where a group of healthcare professionals combined their expertise for the assessment and treatment of an individual patient [16, 29]. ‘Clinician empowerment’ was represented by one study which described giving more control over prescribing choices to clinicians to improve patient outcomes [19]; however, this paper did not specify from where power was transferred.

Category 2: direct clinician participation

The theme ‘direct clinician participation’ describes a concept where the intervention is directly delivered by the clinician to the patient and has six sub-themes. This could be a treatment intervention, a person-centred care activity or referral to another clinician based on the patient’s needs. It is an activity that is instigated and led by the clinician. The sub-theme, ‘teaching via educator’, includes clinicians giving educational information to patients during consultations, and educational sessions/groups set up outside of the consultation [15, 20, 23, 30]. ‘Self-care reminders’ describes a mobile phone app reminding patients to engage with self-care activities [18]. ‘Standard monitoring and usual treatment protocols’ captures studies where participants received their usual care alongside the study intervention [20, 21, 27, 29]. ‘Referrals to promote health change behaviours’ describes those studies which included interventions designed to promote healthy behaviour changes such as smoking cessation, weight loss and exercise regimes [4, 26, 28]. The sub-theme ‘motivational interviewing’ represents two interventions: one utilising motivational interviewing [23] and one utilising motivational interviewing plus focused counselling to influence self-care behaviours [31]. ‘Education digitally-based’ describes online education utilising a web-based online toolkit for supporting informed footwear choices [22].

Category 3: patient instigated participation

‘Patient instigated participation’ reflects interventions where patient initiation was required outside of the influence of the clinician and has four sub-themes. The sub-theme ‘self-care’ represents those studies which required the patient to undertake self-care of their feet between consultations [15, 29, 30]. Two studies [16, 21] incorporated paper-based education resources such as leaflets, and are represented in sub-theme ‘education paper-based’ [15, 16]. The ‘telehealth’ sub-theme includes mobile phone apps, and the use of a temperature mat to detect daily changes in foot temperature [18, 24]. ‘Non-visual foot exam’ represents one study focusing on individuals with significant sight problems utilising smell and touch to identify potential foot issues [25].

How interventions were delivered and types of person-centred care

It was not always clear how interventions were delivered (28%) [4, 20, 25, 27, 30]. Five of the studies (28%) provided ‘face to face education’ [