Addressing ethniC inequaliTies In healthcare use and quality amONg people with painful Diabetic Neuropathy (ACTION-DN)

Background Painful diabetic polyneuropathy is a common and debilitating diabetes complication causing daily discomfort and impacting patients, families and society.

Patients experience unremitting burning, shooting and electric shock pains in the feet, legs and hands, leading to poor quality of life and depression. Healthcare costs associated with PDPN are significant, with estimates exceeding £300m annually in the UK [1]. People from South Asian and African-Caribbean communities have a higher risk of PDPN compared to White ethnicity.

Understanding the extent and causes of this issue is crucial to addressing healthcare-related inequalities in people with PDPN. Research questions 1. Is painful diabetic polyneuropathy (PDPN) under diagnosed in people from ethnic minority backgrounds? 2. What proportion of people from ethnic minority backgrounds receive evidence-based therapies? 3.

How do clinical, psychological, cultural, socioeconomic and health system factors interact and contribute to ethnic disparities in the diagnosis and management of PDPN? 4.

What barriers do healthcare providers face in accurately identifying and managing PDPN in people from ethnic minority backgrounds? Aim To understand ethnic disparities in the diagnosis and management of PDPN. Methods We will perform an exploratory sequential mixed methods study with three work packages (WPs).

A PPI/E group will meet at least 7 times to inform study activities across all WPs.

WP1: Epidemiological study (Month:1-6) Objective Assess the prevalence and treatment of PDPN in people from ethnic minority backgrounds.

Methods We will use UK's CPRD Aurum database, with records of >20 million patients from 1500+ primary care practices, capturing individual-level medical conditions, socio-demographics, prescriptions, and more. We will analyse the prevalence and risk factors for PDPN, focusing on clinical and socio-demographic associations.

WP2: Qualitative study (Month:6-21) Objective Explore the interaction between individual, societal and health system factors, and how they might contribute to ethnic disparities in the diagnosis and management of people with PDPN Methods Using a theory-informed approach, a qualitative study will investigate health-seeking behaviour, treatment acceptance, and outcomes in South Asian and Black people with PDPN.

Five focus groups and 20 semi-structured interviews with healthcare professionals will be conducted. Individual interviews will be offered to participants who prefer them.

Topic guides will be based on the biopsychosocial framework, the findings of WP1 (epidemiological study) and best practice guidelines [2]. Framework analysis will identify factors contributing to ethnic disparities in PDPN diagnosis and management. WP3: Integration (Month:21-24).

Objective Integrate WP1 and WP2 findings to map out pathways leading to ethnic disparities in people with PDPN and identify interventions needed to reduce them.

Methods We'll integrate findings from WP1 and WP2 and hold a stakeholder engagement event, including healthcare professionals, patients and community leaders. Study findings will be discussed, potential interventions identified, and best-practice resources developed.

Impact and Dissemination We'll produce guides for healthcare workers and patients on managing PDPN, disseminate them to patients and NHS staff/services through media and charities, and publish open-access articles. Findings will reach people with diabetes using culturally tailored multimedia/infographics methods.

References 1. CurrieCJ et al. Diabet Med. 2007 24:187-94. 2. GkioulekaA et al. Lancet Public Health. 20238:e463-e472