Answer:
This question is a pretty complicated one, but I believe that the best answer would be this.
First, the Director must have the goals clear: he wants to find out why patients are not getting their annual check-up, and second, implement a program that meets the criteria of the health standards and goals of the community, and find a way to encourage patients to go have their check-ups dones.
Second, the Director must, with the demographic and epidemiologic information that has been received so far, get a team of collaborators together to be able to start a process of home visits for patients with diabetes and who have very seldom, or never, had an annual foot check-up. The purpose is to collect information from the patients themselves as to what has prevented them from getting their check-ups (whether there is a physical reason, or misinformation on the importance of this matter), but also, through interviewing, to get a rapport established with these patients. This rapport will increase the possibility of patients accepting any measures taken by the organization to increase participation in the check-ups.
The third part will, of course, arise from the information collected by the interviewing process. But, basically, assuming that the problems lie with proper education of patients including their full comprehension of the consequences of not having the examinations done, and problems with going to the places where the check-ups will happen, there are two things that can be done. First, initiate a series of sensibilization campaigns so patients have full understanding of what the examination is, and why it is important, and second, establish points (physical places) in the community where patients can easily go to have their check-up, without having to transport themselves, or move, too far from their homes. In cases where patients are not capable of moving themselves for different reasons, teams can be formed that provide the home service.
