The Relationship Between Health Literacy and Diabetes Self-Efficacy and Foot Self-Care in Type II Diabetics

This study was conducted to determine the effect of health literacy on diabetes self-efficacy and foot self-care in type II diabetics. This descriptive correlational study was conducted with 187 people. The research was conducted between 01 June 2021 and 31 December 2021 in a province located in the southeastern region of Turkey. Non-probability purposive sampling was used as the sampling method. An introductory information form, and the Turkish Health Literacy Scale-32 (THLS-32), Diabetes Self-Efficacy Scale and Diabetes Foot Self-Care Behavior Scale (DFSBS) were used in the study. Data were evaluated with frequency, percentage, mean, and correlation analyses using SPSS 25 software. It was determined that the participants had a low education level and were of advanced age, and that the feet of most of the patients were not examined and there were no wounds on their feet. The health literacy level of 57.8% of the participants was found to be insufficient. The mean THLS-32 score was 22.50 ± 10.65, the Diabetes Self-Efficacy Scale mean score was 72.83 ± 11.84, and the Diabetes Foot Self-Care Behavior Scale mean score was 22.60 ± 5.44. It was determined that there was a relationship between the THLS-32 and Diabetes Self-Efficacy score of those with type II diabetes, and that as health literacy increased, diabetes self-efficacy increased (p < 0.05). It was determined that the health literacy level was insufficient, whereas diabetes self-efficacy and foot self-care were at a good level. It was found that as health literacy increased, self-efficacy increased. Information on health literacy is effective in coping with the disease. For this reason, information on health literacy should be given from an early age.

Foot self-care practices among diabetic patients attending a teaching hospital in Tamil Nadu, India

Introduction

Diabetes is a common non-communicable disease in the world. Diabetic foot ulcer is a common complication of diabetes mellitus. Awareness and practice of foot self-care play a major role in the prevention of complications due to diabetic neuropathy.

Methods

Descriptive cross-sectional study was conducted among diabetic patients from Sep 2022 to Feb 2023. A semi-structured questionnaire containing four parts including socio-demographic including clinical details, questions related to knowledge and practice of foot self-care, and clinical examination was used. Ten grams monofilament and 128 Hz tuning fork were used to assess the sensation of the foot.

Results

A total of 211 patients were included. The average age was found to be 58.4 ± 10.0 years and the majority were females (64.0%). The mean percentage score of knowledge on diabetes and foot self-care was found to be 59.6 ± 27.5 and 55.1 ± 11.9, respectively. Participants with low knowledge scores and those who do not engage in regular physical activity had significant poor foot care practices. The majority (54.5%) of the participants had at least one of the clinical problems related to diabetic foot. The most common problem was found to be heel fissures (29.4%), followed by deformed nails (15.2%), callus (5.2%), toe web infection (3.3%), and ulcer (2.8%). Monofilament test and vibration was not detectable in 12.3% and 15.2%, respectively.

Conclusion

More than half of the participants were found to have good diabetic foot self-care practices. Diabetics having good knowledge on foot care and involving in regular physical activity showed good foot self-care practices.

Factors Associated With Self-Efficacy of Foot Self-Care Among Patients With Diabetes Attending a Tertiary Care Center in Saudi Arabia

Several reports have shown self-efficacy to be a reliable way of predicting foot self-care behavior in patients with diabetes. However, at a global level in general, and in Saudi Arabia in particular, investigation of the factors related to self-efficacy in executing foot self-care continues to remain inadequate. This study endeavors to identify the factors associated with the self-efficacy of foot self-care among patients with diabetes in Saudi Arabia. From a tertiary diabetes care center in Saudi Arabia, 175 patients with diabetes were selected to participate in this cross-sectional study. Employing the Arabic version of the Foot Care Confidence Scale (FCCS), the principal end results and the sociodemographic, clinical, and psychosocial independent variables were collected and assessed. From the total reported FCCS score, the mean was found to be 28.1 ± 8.2. Multiple linear regression analysis indicated 2 independent factors were positively associated with a higher reported FCCS score; being middle-aged (< 60 years old) (β=0.31, P< .01) and having a higher score on the Foot Care Outcome Expectations Scale (FCOES) (β=0.36, P< .01). In conclusion, patients with diabetes in Saudi Arabia have a mild level of self-efficacy to perform the needed foot self-care. Therefore, this has turned the spotlight on the young or middle-aged < 60-year-old Saudi population with diabetes as the target group, making them the priority for future self-efficacy promotion programs to upgrade the level of foot self-care.

Foot Self-Care Behaviour among People with Type 2 Diabetes mellitus Living in Rural Underserved Area of North India: A Community-Based Cross-Sectional Study

The objective of this study was to ascertain the foot self-care behaviour and its associated factors among people with type 2 diabetes mellitus (T2DM) living in the rural resource-constrained health setting of Punjab, North India. A community based cross sectional study was undertaken in the randomly selected underserved rural area of District Fatehgarh Sahib, Punjab, North India. A pre-validated Nottingham Assessment of Functional Footcare (NAFF) scale was administered to assess foot self-care behaviour, and participants were classified based on the percentage of a maximum possible score of 84 on the scale, as poor, if the score was <50%, satisfactory if score 50%-70% and >70% good foot self-care behaviour. A total of 700 participants' responses were recorded. The study results revealed that 84% (588) of the respondents had poor, 16% (112) had satisfactory, and none were following good foot self-care behaviour. An outcome of multivariable logistics regression suggested satisfactory foot self-care behaviour was significantly associated with foot self-care education, with an adjusted odds ratio (aOR) of 2.83 (95%, CI:1.62 - 4.93; p <0.01) among respondents who had received foot self-care education, literate than illiterate (aOR 2.50 95%, CI:1.31- 4.74; p <0.01) and women compared to men (aOR 1.69 95%, CI: 1.06 -2.70; p -0.26). This study revealed that foot self-care behaviours were alarmingly low among people with T2DM living in rural resource-constrained health settings of Punjab, North India, suggesting an urgent need to disseminate foot self-care education to prevent diabetes foot related complications.

Diabetic Foot Self-Care Practices Among Adult Diabetic Patients: A Descriptive Cross-Sectional Study

BACKGROUND

Adequate foot care and regular foot examinations along with optimal glycemic control are effective strategies to prevent foot ulceration.

AIM

The aim of this study was to describe the patterns of foot self-care practice among diabetic patients attending an ambulatory clinic.

METHODS

A descriptive cross-sectional study was conducted at the ambulatory clinic of Jimma Medical Center. A consecutive sampling technique was used. The data were analyzed by SPSS version 20 and descriptive statistics were used to describe the findings.

RESULTS

A total of 370 diabetic patients (55.9% male and 68.4% type 2) were interviewed. The mean (±SD) age of the patients was 46.47±13.63 years. Over one-third (35.7%) of the patients had a previous history of foot ulcer. The majority of the patients self-inspect (92.5%) and wash (82.7%) their foot at least daily, respectively. In this study, 12.2% of the patients never inspected the inside of their footwear before putting them on and 42.4% of the patients never dry between their toes after washing. Most (63.5%) of patients never used moisturizing creams to lubricate the dry skin. In this study, 23.0% and 27.6% of the patients walk in sandals/slippers and in shoes without socks most of the time, respectively. Only 27.3% of the patients changed their socks daily. Majority (78.4% and 86.5%) of the patients never walk barefoot around and outside their house, respectively, and 75.1% of the patients never put their feet near the fire.

CONCLUSION

Diabetic patients were not adequately self-inspect and wash their foot at least daily, dry after wash and moisturize the dry skin. They walk barefoot, in sandals/slippers, and in shoes without socks. Therefore, clinicians should counsel every diabetic patient about the importance of foot self-inspection, foot hygiene, and the risk of walking barefoot, wearing sandals/slippers, and shoes without socks at every follow-up visit.

Health education programmes to improve foot self-care practices and foot problems among older people with diabetes: a systematic review

AIMS AND OBJECTIVES

To assess the effectiveness of health education programmes to improve foot self-care practices and foot problems among older people with diabetes.

BACKGROUND

The complications of diabetes among older people are a major health concern. Foot problems such as neuropathy, ulcer and ultimately amputation are a great burden on older people with diabetes. Diabetes foot education programmes can influence the behaviour of older people in practising foot self-care and controlling the foot problems. However, the educational approaches used by the educators are different. Therefore, it is important to assess the education programmes from various evidence-based practices.

DESIGN

Six databases, EBSCOhost medical collections (MEDLINE, CINAHL, Psychology and Behavioral Sciences Collection), SAGE, Wiley Online Library, ScienceDirect, SpringerLink and Web of Science, were used to search for articles published from January 2000 to March 2015. The search was based on the inclusion criteria and keywords including 'foot', 'care' and 'diabetes'. Fourteen studies were assessed and reviewed in the final stage.

CONCLUSIONS

Health education programmes varied according to their design, setting, approach, outcome measured and results. Foot assessment, verbal and written instructions and discussion were proved to improve the foot self-care and foot problems. Subsequent follow-ups and evaluations had a significant effect. An improvement was observed in foot self-care scores and foot problems (such as neuropathy, foot disability, lesion, ulcer, tinea pedis and callus grade) after implementation of the health education programme.

IMPLICATIONS FOR PRACTICE

The findings of this study support the claim that a health education programme increases the foot self-care scores and reduces the foot problems. However, there were certain methodological concerns in the reviewed articles, indicating the need for further evaluation. In future, researchers and practitioners must implement a vigorous education programme focusing on diabetes foot self-care among the older population.

Improving foot self-care knowledge, self-efficacy, and behaviors in patients with type 2 diabetes at low risk for foot ulceration: a pilot study

The pilot study aimed to explore the effects of an educational intervention on patients' foot self-care knowledge, self-efficacy, and behaviors in adult patients with type 2 diabetes at low risk for foot ulceration. The intervention consisted of three sessions and was given over a 3-week period. A total of 70 eligible consenting participants were recruited for this pilot study. Fifty-six participants completed the study. The outcomes were assessed at pretest, following the first two sessions, and 3-month follow-up. The findings indicated that the foot self-care educational intervention was effective in improving foot self-care knowledge, self-efficacy and behaviors in adult patients with type 2 diabetes at low risk for foot ulceration. The findings support the effects of the intervention. Future research should evaluate its efficacy using a randomized clinical trial design, and a large sample of patients with type 2 diabetes at low risk for foot ulcerations.

Feasibility, acceptability and effects of a foot self-care educational intervention on minor foot problems in adult patients with diabetes at low risk for foot ulceration: a pilot study

OBJECTIVES

The objectives of the pilot study were to examine the feasibility and acceptability of the foot self-care educational intervention, and to explore its preliminary effects on reducing the occurrence of minor foot problems in adult patients with diabetes at low risk for foot ulceration.

METHODS

A one-group-repeated-measures design was used. The intervention given over 3 weeks consisted of a 1 hour 1-on-1 provider-patient interaction to discuss foot self-care strategies, 1 hour hands-on practice of strategies and 2 10-minute telephone contact booster sessions. Of the 70 eligible consenting participants, 56 completed the study. The outcomes were assessed at pretest and at 3-month follow-up. Chi-square and Fisher's exact test were used to examine changes in outcomes over time.

RESULTS

The findings provided initial evidence suggesting the foot self-care educational intervention is feasible and acceptable to adult patients with type 2 diabetes mellitus. It was effective in reducing the occurrence of minor foot skin and toenails problems (all p<0.05) at 3-month follow up.

CONCLUSIONS

The findings support the effects of the intervention. Future research should evaluate its efficacy using a randomized clinical trial design, and a large sample of patients with diabetes at low risk for foot ulcerations.

Foot care education in patients with diabetes at low risk of complications: a consensus statement

AIMS

To define and agree a practical educational framework for delivery by all healthcare professionals managing patients with diabetes, particularly those at low risk of developing foot complications.

METHODS

A consensus meeting of a multidisciplinary expert panel. Prior to the meeting, relevant clinical papers were disseminated to the panel for review. The consensus was largely based upon the experts' clinical experience and judgement.

RESULTS

Four main health behaviours were identified for those at low risk of developing foot complications, namely: control of blood glucose levels; attendance at annual foot screening examination; reporting of any changes in foot health immediately; and the engagement in a simple daily foot care routine.

CONCLUSION

There is currently little evidence-based literature to support specific foot care practices. Patients with diabetes at low risk of developing complications should be encouraged to undertake a basic foot care regimen to reduce their likelihood of developing complications.