Enhancing foot care education and support strategies in adults with type 2 diabetes: A qualitative study

BACKGROUND

People with diabetes are susceptible to serious and disabling foot complications, which increase their morbidity and mortality rates. Examining the perspectives of people with diabetes on their foot care routines could help elucidate their beliefs and offer practical ways to prevent foot problems.

PURPOSE

We explored the perspectives of adults with diabetes on their foot care practices to identify and enhance foot care education and support strategies.

METHODOLOGY

Using the Zoom platform, 29 adults with diabetes completed a 3-month telehealth educational program, during which interviews were conducted. This article reports the results of thematic content analysis of the qualitative data. Coded participant statements were organized into categories and reexamined to identify emergent themes.

RESULTS

Analysis of participants' perceptions revealed four main themes of influences that facilitated and/or hindered their foot care practices. Foot care behaviors were facilitated by patients' personal knowledge of others with diabetes-related foot consequences (theme 1). Foot care practices were hindered by the emotional impact of living with diabetes (theme 2), and the physical, social, and lifestyle limitations associated with foot care (theme 3). Finally, patients noted that interactions with family could be either a facilitator or hindrance to their foot care routines (theme 4).

CONCLUSIONS

These findings highlight multiple patient-centered factors related to personal, physical, psychosocial, and cultural influences that affect foot care behaviors.

IMPLICATIONS

An understanding of how patients manage diabetes-related foot care can help nurse practitioners enhance foot care education and support strategies in this population.

Impact of Gaming (Gamification) on Diabetes Self-Care Behaviors and Glycemic Outcomes Among Adults With Type 2 Diabetes

PURPOSE

The purpose of this systematic review was to determine if the use of gaming (gamification) among persons with type 2 diabetes improves diabetes self-management behaviors and diabetes outcomes.

METHODS

A systematic review was conducted using electronic databases including MEDLINE, Embase, Web of Science, and CINAHL. Studies reporting on the impact of gaming on at least 1 of the Association of Diabetes Care and Education Specialists self-care behaviors (ADCES7) were included.

RESULTS

The review included 9 studies, 8 of which were of strong/high quality. Five of the self-care behaviors were addressed in at least 1 of the included studies. However, taking medications and problem solving were not reported in any of the studies. Physical activity and self-efficacy or quality of life (healthy coping) were the most frequently reported ADCES7 behaviors. Six of the studies used A1C as an outcome measure, with a reduction reported in all the studies except 1.

CONCLUSION

Type 2 diabetes affects a person holistically, necessitating a range of self-care behaviors to effectively manage the chronic condition. Novel gaming interventions may improve coping mechanisms, lifestyle behaviors, medication engagement, and monitoring of risks and problems, all of which are essential in facilitating optimal diabetes self-management.

A Nurse-Led Telehealth Program for Diabetes Foot Care: Feasibility and Usability Study

BACKGROUND

Diabetes mellitus can lead to severe and debilitating foot complications, such as infections, ulcerations, and amputations. Despite substantial progress in diabetes care, foot disease remains a major challenge in managing this chronic condition that causes serious health complications worldwide.

OBJECTIVE

The primary aim of this study was to examine the feasibility and usability of a telehealth program focused on preventive diabetes foot care. A secondary aim was to descriptively measure self-reported changes in diabetes knowledge, self-care, and foot care behaviors before and after participating in the program.

METHODS

The study used a single-arm, pre-post design in 2 large family medical practice clinics in Texas. Participants met individually with the nurse practitioner once a month for 3 months using synchronous telehealth videoconferencing. Each participant received diabetes foot education guided by the Integrated Theory of Health Behavior Change. Feasibility was measured with rates of enrollment and program and assessment completion. Usability was measured with the Telehealth Usability Questionnaire. Diabetes knowledge, self-care, and foot care behaviors were measured with validated survey instruments at baseline, 1.5 months, and 3 months.

RESULTS

Of 50 eligible individuals, 39 (78%) enrolled; 34 of 39 (87%) completed the first videoconference and 29 of 39 (74%) completed the second and third videoconferences. Of the 39 who consented, 37 (95%) completed the baseline assessment; 50% (17/34) of those who attended the first videoconference completed the assessment at 1.5 months, and 100% (29/29) of those who attended the subsequent videoconferences completed the final assessment. Overall, participants reported a positive attitude toward the use of telehealth, with a mean Telehealth Usability Questionnaire score of 6.24 (SD 0.98) on a 7-point scale. Diabetes knowledge increased by a mean of 15.82 (SD 16.69) points of 100 (P<.001) from baseline to 3 months. The values for the Summary of Diabetes Self-Care Activities measure demonstrated better self-care, with participants performing foot care on average 1.74 (SD 2.04) more days per week (P<.001), adhering to healthy eating habits on average 1.57 (SD 2.12) more days per week (P<.001), and being physically active on average 1.24 (SD 2.21) more days per week (P=.005). Participants also reported an improvement in the frequency of foot self-examinations and general foot care behaviors. The mean scores for foot care increased by a mean of 7.65 (SD 7.04) points (scale of 7 to 35) from baseline to 3 months postintervention (P<.001).

CONCLUSIONS

This study demonstrates that a nurse-led telehealth educational program centered on diabetes foot care is feasible, acceptable, and has the potential to improve diabetes knowledge and self-care, which are precursors to preventing debilitating foot complications.

PSUN164 Feasibility of a telehealth-delivered diabetes foot care educational program

Background

Diabetes-related nerve damage, foot ulcerations, and amputations occur as consequences of type 2 diabetes mellitus that is prevalent worldwide.

Aims

The study aims to investigate the preliminary effects and the feasibility of a telehealth educational program in patients with type 2 diabetes.

Methods

We conducted a single-arm, pre-mid-post measure study in two primary care practices in Texas. A total of 29 participants who met eligibility criteria (type 2 diabetes, Internet access, and English speaking) met with the research team once a month for 3 months via Zoom. The intervention involved telehealth visits with a board-certified family nurse practitioner/nurse educator for diabetes foot care and counseling, diabetes education, and discussion of self-management behaviors. Diabetes foot care behaviors, knowledge, and self-management activities were measured at baseline, 1.5 months, and 3 months.

Results

Initially, the mean score of the Diabetes Foot Self-Care Behavior Scale (DFSBS) was 17.75. The mean score of DFSBS increased to 21.59 at 1.5 months and rose to 25.46 at 3 months, indicating an improved frequency of foot care behaviors. Knowledge of diabetes was 70.48% correct at baseline and increased to 75.92% at 1.5 months and 83.89% at 3 months. At 1.5 months, the mean scores of the Summary of Diabetes Self-Care Activities improved by 0.4 days/week (d/w) for general diet, 0.29 d/w for exercise, 0.21 d/w for blood glucose testing, and 0.69 d/w for foot care. At 3 months, these values increased by 1.4 d/w for general diet, 1.13 d/w for exercise, 2.02 d/w for blood glucose testing, and 1.71 d/w for foot care compared with baseline. Of those enrolled, 87.18% completed the first telehealth visit, while 74.36% completed the second and third telehealth visits. Overall, 74.36% completed all three telehealth visits.

Conclusions

In two large primary care practices in Texas, a telehealth educational program that was centered on diabetes foot self-care management led to an improvement in self-care behaviors and knowledge for patients with type 2 diabetes. Clinical Implications: The promising results from this pilot study demonstrated the feasibility of a telehealth-delivered diabetes foot care educational program for patients with type 2 diabetes. Innovative strategies such as incorporating telehealth visits with in-person examinations may improve diabetes monitoring and prevent diabetes-related foot complications. Further research is needed to determine the long-term effects of a multi-disciplinary and personalized telehealth approach for monitoring diabetes foot care and self-management behaviors.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Feasibility and efficacy of remotely supervised cranial electrical stimulation for pain in older adults with knee osteoarthritis: A randomized controlled pilot study

Cranial electrical stimulation (CES) is a noninvasive brain stimulation technique that has been shown to improve pain. However, few studies have investigated the potential benefits associated with remotely supervised CES in older adults with knee osteoarthritis (OA). The aim of this study was to examine the feasibility and preliminary efficacy of remotely supervised CES via secure videoconferencing software on clinical pain severity, experimental pain sensitivity, and pain-related cortical response in older adults with knee OA. Thirty participants with symptomatic knee OA pain were randomly assigned to receive 10 daily sessions (60 min each) of remotely supervised CES (n = 15) or sham CES (n = 15) over two weeks. We measured clinical pain severity via a Numeric Rating Scale, experimental pain sensitivity (e.g., heat pain sensitivity, pressure pain sensitivity, and conditioned pain modulation) using quantitative sensory testing, and pain-related cortical response via functional near-infrared spectroscopy imaging. We also measured participant satisfaction with treatment using the Client Satisfaction Questionnaire. Active CES significantly reduced scores on the Numeric Rating Scale and increased heat pain threshold, pressure pain thresholds, and conditioned pain modulation. We also found significant changes in pain-related cortical hemodynamic activity after CES. Participants tolerated CES well without serious adverse effects and were satisfied with the treatment. Our findings demonstrate promising clinical efficacy of remotely supervised CES for older adults with knee OA.

Barriers to Accurate Blood Pressure Measurement in the Medical Office

Background: Despite the high prevalence of blood pressure (BP) measurement errors in the outpatient setting, little is known about why primary care clinics struggle to achieve consistently accurate BP measurements in routine practice. We investigated barriers affecting measurement of BP for adult patients in primary care. Methods: We conducted a qualitative evaluation in 6 adult primary care clinics. BP measurement was observed during 54 routine patient encounters. Six managers completed semistructured interviews and 18 clinical staff members participated in focus group discussions. We used an inductive, data-driven approach to identify and organize findings into cohesive, overarching themes describing factors affecting BP measurement. Results: Observed errors in BP measurement spanned the entire spectrum of steps required to obtain BP properly. Barriers to proper BP measurement were related to staff knowledge and behavior (inadequate knowledge, training, and feedback); workflow constraints (need to multitask, inadequate time); and equipment issues (BP monitors, seating). Patient characteristics and behavior also affected BP measurement. Conclusions: Correct measurement of BP is affected by a wide range of factors and is challenging to accomplish consistently in primary care. These findings may inform the design of performance improvement programs to maximize the quality of BP measurement in the outpatient setting.