Diabetes foot care education movies for Aboriginal people: Bran nue leg

Adequate knowledge of diabetes is crucial to diabetes care and the prevention of diabetes complications. Aboriginal people are three times more likely than non-Aboriginal people to have diabetes in Australia.¹ In Western Australia, Aboriginal people experience significantly higher rates of lower extremity amputation than non-Aboriginal people, and 98% of these amputations are diabetes related.² Additionally, Aboriginal people may experience barriers to accessing or utilising diabetes education in Western Australia.^3,4 The need for culturally appropriate diabetes education for Aboriginal people appears in four current Western Australia Department of Health documents.^5–8

As part of a High Risk Foot intervention in Western Australia, we aimed to respond to these research findings and provide a practical way to implement state directives for Aboriginal foot health. Two diabetes foot care education movies have been created and are available as DVDs or can be viewed online at https://vimeo.com/69131503 and https://vimeo.com/85494467. These movies were produced in partnership with Goolarri Media Enterprises,⁹ an Aboriginal media company. Local knowledge was utilised to ensure that the movie content is appropriate, respectful and based on what works. Given the general dearth of engaging and culturally relevant resources, we are writing to advise practitioners everywhere of the availability of these resources and to encourage their wider use; they can be freely downloaded and any feedback on them and how they are used would be welcome.

The first production, Bran nue leg, is aimed at Aboriginal people ‘at-risk’ of developing diabetes. Baamba, a Kimberley Aboriginal Elder and celebrity who is also an amputee, shares his ‘edutainment’ story. Edutainment is a form of entertainment designed to engage, educate and amuse. The movie embeds relevant health and wellbeing messages in an entertaining piece, intending to make a difference in health literacy. The title is a play on Bamba’s role in the successful Australian movie Bran nue day, which centres on Aboriginal themes.

The second movie, Deadly (and not in a good way), is aimed at people living with an amputation. In this movie, Kimberley Aboriginal community members share their stories but without the humour of edutainment. Both movies aim to improve health literacy related to ‘at-risk’ feet and encourage earlier presentation to health services for foot problems by Aboriginal people living in the Kimberley region of Western Australia, which has the highest rate of lower extremity amputation in Western Australia.

Many people with diabetes have little awareness of the risks associated with their disease, and the vascular and neurological deficits that develop by stealth, increasing the risks of injury, infection and amputation of their lower limbs. While some of the humour and local characters in the movies are particularly relevant to the Aboriginal people of the Kimberley region, Indigenous people worldwide have higher rates of amputation than non-Indigenous people as a result of their higher rates of diabetes and poorer access to health services.¹⁰ The National Evidence-Based Guideline on Prevention, Identification and Management of Foot Complications¹¹ encourages all practitioners to assess feet, providing an excellent opportunity to educate patients about how diabetes can affect their feet.