{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T07:48:55Z","timestamp":1782200935223,"version":"3.54.5"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Diabetic foot ulceration (DFU) contributes significantly to diabetes\u2010related morbidity and amputation. In Barbados, where amputation rates are among the highest globally, the influence of socioeconomic factors on ulceration outcomes remains underexplored. Educational attainment, a social determinant of health, may influence health behaviours, engagement with healthcare services, and ultimately clinical outcomes. This study examines whether educational attainment is associated with diabetic foot ulcer severity, as measured by the SINBAD scoring system, and six\u2010week healing outcomes among inpatients with DFU. A prospective observational study was conducted over 6\u2009months at Barbados' sole public hospital. A total of 176 participants admitted with a diagnosis of DFU were recruited. Baseline demographics, comorbidities, and ulcer characteristics were collected, and SINBAD scores were determined. Random forest modelling was employed to evaluate predictors of complete healing at 6\u2009weeks and to assess ulcer severity stratified by educational attainment. Of the cohort, 17.5% reported primary education as their highest attainment level, compared with 2.9% of the general adult population. The mean SINBAD score was 2.45 among those with primary education and 2.51 among those with secondary education (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&gt;\u20090.05). No statistically significant association was found between educational attainment and healing outcomes at 6\u2009weeks. Educational attainment in this inpatient DFU cohort was lower than that of the general Barbadian population; however, it was not significantly associated with ulcer severity or six\u2010week healing outcomes. In a universal healthcare setting, equitable access to care may attenuate the effect of educational attainment on clinical outcomes. These null findings highlight the need for future adequately powered studies incorporating health literacy assessment and key clinical confounders. Nonetheless, the observed disparity in educational attainment among DFU inpatients suggests that foot health education initiatives should be designed to be accessible to individuals across all educational levels.\n                  <\/jats:p>","DOI":"10.1111\/iwj.70969","type":"journal-article","created":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T05:04:47Z","timestamp":1780722287000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Educational Attainment and Diabetic Foot Ulceration: Outcomes From the Barbados Diabetic Foot Study"],"prefix":"10.1111","volume":"23","author":[{"given":"Laura Nicole","family":"Lovell","sequence":"first","affiliation":[{"name":"Faculty of Medical Sciences The University of the West Indies  Bridgetown Barbados"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7072-1271","authenticated-orcid":false,"given":"Nachiappan","family":"Chockalingam","sequence":"additional","affiliation":[{"name":"University of Staffordshire  Staffordshire UK"},{"name":"Reading Central PCN \u2010 NHS England  Reading UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Davies","sequence":"additional","affiliation":[{"name":"University of Staffordshire  Staffordshire UK"},{"name":"Leeds Community Healthcare NHS Trust  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Chami","sequence":"additional","affiliation":[{"name":"Faculty of Science and Technology The University of the West Indies  Bridgetown Barbados"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie S.","family":"Greaves","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences The University of the West Indies  Bridgetown Barbados"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci22\u20100043"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcd.2020.10.001"},{"key":"e_1_2_13_4_1","unstructured":"D. J.MaglianoandE. J.Boyko \u201cIDF Diabetes Atlas [internet] \u201d(2013)."},{"key":"e_1_2_13_5_1","unstructured":"N.Unwin A. M. C.Rose K. S.George I. R.Hambleton andC.Howitt \u201cThe Barbados Health of the Nation Survey: Core Findings \u201d(2015)."},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.14\u20104\u2010367"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40200\u2010025\u201001726\u20101"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010017\u20104522\u2010x"},{"key":"e_1_2_13_9_1","doi-asserted-by":"crossref","unstructured":"J.Riley C.Antza P.Kempegowda et\u00a0al. \u201cSocial Deprivation and Incident Diabetes\u2010Related Foot Disease in Patients With Type 2 Diabetes: A Population\u2010Based Cohort Study \u201d(2021).","DOI":"10.2337\/figshare.13476807"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11185431"},{"key":"e_1_2_13_11_1","unstructured":"O.SolarandA.Irwin \u201cA Conceptual Framework for Action on the Social Determinants of Health. Social Determinants of Health Discussion Paper 2 (Policy and Practice) \u201d(2010)."},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2021.08.009"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20102667(24)00018\u20105"},{"key":"e_1_2_13_14_1","unstructured":"Organisation for Economic Co\u2010Opearation and Development Education at a Glance 2025: OECD Indicators(OECD Publishing 2025) https:\/\/doi.org\/10.1787\/1c0d9c79\u2010en."},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(20)30144-4"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.9734\/jammr\/2026\/v38i16058"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/jfa2.70107"},{"key":"e_1_2_13_18_1","doi-asserted-by":"crossref","unstructured":"A.Bancalari S.Berlinski G.Buitrago andM.Vera\u2010Hern\u00e1ndez \u201cHealth Systems and Health Inequalities in Latin America \u201d(2023).","DOI":"10.18235\/0005243"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2021.100870"},{"key":"e_1_2_13_20_1","volume-title":"The Education System of the Americas","author":"Brissett N.","year":"2021"},{"key":"e_1_2_13_21_1","volume-title":"The Education Systems of the Americas","author":"Nom B.","year":"2021"},{"key":"e_1_2_13_22_1","unstructured":"Barbados Statistical Service \u201c2021 Population and Housing Census Report \u201d(2023)."},{"key":"e_1_2_13_23_1","unstructured":"Planning Research and Development Unit of the Ministry of Education Youth Affairs and Culture \u201cHistorical Developments of Education in Barbados 1686\u20132000 \u201d(2000)."},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev\u2010publhealth\u2010031816\u2010044628"},{"key":"e_1_2_13_25_1","unstructured":"StataCorp LLC \u201cStata Statistical Software \u201d(2023)."},{"key":"e_1_2_13_26_1","unstructured":"R Core Team \u201cR: A Language and Environment for Statistical Computing \u201d(2023)."},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010017\u20104522\u2010x"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.14-4-367"}],"container-title":["International Wound Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.70969","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/iwj.70969","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.70969","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T07:23:09Z","timestamp":1782199389000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/iwj.70969"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":27,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/iwj.70969"],"URL":"https:\/\/doi.org\/10.1111\/iwj.70969","archive":["Portico"],"relation":{},"ISSN":["1742-4801","1742-481X"],"issn-type":[{"value":"1742-4801","type":"print"},{"value":"1742-481X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2025-11-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70969"}}