Co-designing a logic model for community-based diabetic foot screening in primary care: A participatory study

Background. Diabetic foot complications, including ulcers and amputations, lead to reduced quality of life and premature death, and up to 85% of amputations could be prevented through optimal prevention. In Canada, preventive foot care remains fragmented and difficult to access, and to our knowledge, no recognized screening program currently exists in Quebec primary care. This study aimed to co-design a logic model specifying the inputs, activities, outputs, and expected outcomes of an equitable community-based diabetic foot screening program in primary care. Methods. Using a participatory co-design approach following GUIDED reporting guidelines, we developed the logic model in two steps: 1) a rapid review synthesizing implementation determinants and strategies from 44 diabetic foot screening programs across 16 countries, and 2) a stepwise co-design process structured around seven meetings of an interdisciplinary steering committee (N = 23) comprising patient partners, clinicians, managers, community representatives, trainees, and researchers at a University Family Medicine Group (U-FMG) in Trois-Rivières, Quebec, Canada. The process was guided by the Knowledge-to-Action framework, the Consolidated Framework for Implementation Research, and Quebec’s Ministry of Health and Social Services proximity services reference framework, and was evaluated through an anonymous mid-course survey and a final reflexive workshop. Results. The final logic model articulates the program theory for early detection of diabetic foot complications, specifying required resources, standardized screening and follow-up activities, corresponding outputs, and time-phased expected outcomes, with equity embedded across most of the components. The mid-course evaluation was positive (mean item scores 4.0 to 4.6 out of 5.0), and participants highlighted inclusive participation and the recognition of different voices. Conclusions. The model provides an evidence-informed roadmap for implementing and evaluating equitable diabetic foot screening at the U-FMG and is intended to be transferable, with deliberate adaptation, to similar primary care settings.