Exploring Endogenous and Exogenous Determinants of Diabetic Foot Ulcer Management Among Healthcare Professionals in Ghana: A Cross-Sectional Study

Abstract

Background: Diabetic foot ulcers (DFUs) represent a significant health burden in Ghana, with outcomes influenced by both healthcare professionals’ internal capacities and the environments in which they work. Objective: This study aimed to examine how endogenous factors (such as training, knowledge, and experience) and exogenous factors (including infrastructure, resources, and institutional policies) shape healthcare professionals’ knowledge and practices in DFU management in Ghana. Methods: A cross-sectional quantitative study involving 231 healthcare professionals across three hospitals in Bosomtwe District was conducted. Data were collected using structured questionnaires and analyzed using descriptive and inferential statistics. Results: Educational level, professional experience, and previous DFU training significantly influenced knowledge and practice. System-level barriers, such as lack of wound care equipment, inadequate staff training, insufficient multidisciplinary collaboration, and the absence of a podiatrist, hindered effective DFU management. Both types of factors were strongly associated with management outcomes (p < 0.05). Conclusion: Improving outcomes for diabetic foot ulcers in Ghana requires both the continuous development of healthcare workers’ skills and the resolution of system-level barriers, such as access to resources and standardized care protocols. Central to this effort is the inclusion of podiatrists within the healthcare team, as their expertise is critical for comprehensive foot assessment, early intervention, and patient education. By ensuring podiatrists are part of multidisciplinary interventions that address both individual and systemic factors, Ghana can significantly reduce DFU-related complications and prevent unnecessary amputations.