Original researchThe effectiveness of foot care education on people with type 2 diabetes in Tehran, Iran
Introduction
Diabetes mellitus is increasing in incidence; it represents a major health problem for the 21st century. Indeed, the total number of patients with diabetes has been projected to rise from 171 million in 2000 to 366 million in 2030 [1]. Diabetic wounds and especially diabetic foot is one of the major health problems and is the source of enormous costs to healthcare services [2], [3], [4].
Foot ulceration is estimated to affect 15% of people with diabetes at some time in their life and 70% of healed foot ulcers recur within five years [3], [5].
Studies have shown that diabetic people with foot ulceration suffer from reduced quality of life in terms of pain, restricted mobility, time lost from work and reduction in social activities, leading to social isolation and loneliness [2], [6], [7], [8].
The management of the diabetic foot disease is primarily focused on avoiding lower extremity amputation. This goal is carried out through 3 main strategies: identification of the “at-risk” foot, prompt and effective treatment of the acutely diseased foot, and prevention of further problems. Education to the patients is of a vital value to succeed in any of the mentioned program. Some interventions have shown that the regular foot examinations could reduce the frequency of lower extremity amputations by 49–85% and also could prevent from the diabetes-related lower-extremity amputations [9], [10].
Since the options for specific therapy are limited [11], great emphasis is already placed on the prevention and on the foot care education in particular [12], [13], [14], [15].
While the importance of the patients’ knowledge is inevitable, the effectiveness of the education in reducing ulcer incidence has not been clearly demonstrated, as indicated by recent systematic [16] and non-systematic [17], [18] reviews. A reduced incidence of new foot ulcers has been shown in some studies when the foot care education was included as part of an integrated package for the diabetes care delivered to selected and relatively disadvantaged groups in the USA [19], [20]; however, this has not been confirmed in other studies [21], [22], [23], [24], [25], [26].
The aim of this study was to evaluate the impact of a simple educational program on the knowledge and practice of people with type 2 diabetes in relation to the at risk foot in Tehran, Iran.
Section snippets
Setting and patients
One hundred and forty-eight people with type 2 diabetes underwent a structured interview using a 32-item designed questionnaire (DiFoKaPS-32) about their knowledge of foot care standards in diabetes and their personal foot care behaviours.
This study was performed in the Diabetic Foot Care Centre at the Institute of Endocrinology and Metabolism (IEM) affiliated to Iran University of Medical Sciences from October 2006 to July 2007. It was also approved by IEM Ethics Research Committee.
The
Results
One hundred and forty-eight people with type 2 diabetes enrolled in the study. The mean age of the participants was 57 years (95% CI = 55.2–58.6 years) and 65.5% of them were females (female-to-male ratio = 2:1). The mean diabetes duration of the studied subjects was 10 years (95% CI = 8.7–11.2 years); and they were of a mean body mass index (BMI) of 27.7 kg/m2 (95% CI = 27.0–28.3). A total of thirty-six people (24.3%) from among 148 subjects have had BMI ≤ 25 kg/m2; and the remaining 112 ones (75.6%) were
Discussion
Overall, the results of our study showed that the applied educational intervention aimed at patients with type 2 diabetes have improved their knowledge and practice about diabetic foot care. These findings have already been supported by the previous studies [15], [16], [17], [18], [28]. Our pedagogical method of person-by-person face-to-face method with an additional written application dedicated to each person showed a great impact on the both knowledge and practice of diabetic people about
Conclusions
In conclusion the findings of our study have shown that a simple face-to-face education is an effective and applied method to improve the knowledge about foot care. It has also shown that it could increase the motivation and change the behaviour of people with type 2 diabetes regarding their feet. In addition, the obese patients referring to a diabetic clinic need much more attentions and tighter care programs.
Conflict of interest statement
None.
Acknowledgments
The authors wish to thank to the staff in Institute of Endocrinology and Metabolism affiliated to Iran University of Medical Sciences.
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2019, Diabetes Research and Clinical PracticeCitation Excerpt :This indicated that regardless of group, all participants reduced p-FDB scores across 6 months; and regardless of time, the intervention group had better p-FDB scores (lower) than those in the control group. The present findings are in accordance with other research which found positive outcomes from foot care education interventions in enhancing preventive foot care practice despite variability in target groups (i.e. participants’ risk of foot ulceration), educators, mode of intervention (i.e. groups, individuals), intervention structures (intensive, home visit, phone call follow-up), multifaceted teaching strategies, whether theory-driven, and content covered [20,23,24,40–46]. Most of the previous studies identified short-term effects of interventions in changing foot care behaviour, and there are limited studies which examined long-term effects.
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2017, Journal of Clinical and Translational EndocrinologyCitation Excerpt :On average, we observed an increase in foot care activities frequency among participants in the study, providing indication that access to culturally adapted education can be a powerful tool to increase awareness and promote behavior change strategies among patients. Improvements in different health outcomes, including self-care activities, have been shown in previous studies [27,31,34,41]. Specifically, improvements in knowledge and skills related to foot self-care have been consistently reported across studies [25,35,37,42].
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2015, Journal of Tissue ViabilityCitation Excerpt :In our study, the only two questions where the patient scored lower were those related to the acquisition of footwear and socks, with a mean score of 2.31 and 2.21, respectively. This reveals that the diabetic education was adequate, as indicated in other studies [43], but that the patient had difficulties in applying this knowledge to everyday life because of barriers to find the recommended foot wear. Nevertheless, this information should be interpreted with caution, as the subjects of our study were patients without amputations, indicating that their knowledge of self-care of their feet was greater than in amputees, who are the main population included in most studies, as it has been confirmed that education helps reduce the number of amputations [2].
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