Foot care practices, services and perceptions of risk among medicare beneficiaries with diabetes at high and low risk for future foot complications

Preventive foot self-care practice and associated factors among diabetic patients attending the university of Gondar comprehensive specialized referral hospital, Northwest Ethiopia, 2021

BACKGROUND

Diabetes mellitus is emerging as a major worldwide health problem that has a social, financial, and developmental impact on developing countries. Foot complications are among the most serious and costly complications of diabetes which lead to lower extremity amputation due to diabetic foot ulcers. Poor diabetic foot self-care practice is identified by different studies as a major contributing factor to diabetic foot ulcers. Therefore, this study was intended to assess foot self-care practice and associated factors among diabetic patients attending the University of Gondar comprehensive specialized referral hospital.

METHODS

A hospital-based cross-sectional study was conducted from July 1 to August 30, 2021, at the University of Gondar comprehensive specialized referral hospital. A systematic random sampling technique was employed to select 384 diabetic patients. A structured pretested interviewer-administered questionnaire was used to collect data. The data was entered in epi-info version 7, analyzed using SPSS version 21, and presented using frequencies, percentages, tables, and graphs. Bivariable and multivariable analyses were investigated using a binary logistic regression model. P-value < 0.05 and an odds ratio with a 95% confidence interval were used to determine the significance and strength of the association.

RESULTS

Of the 384 diabetic patients, 46.4% (95% CI (41.1%-51.6%)) of them had poor foot self-care practice. Being male [AOR = 0.54, 95% CI (0.32, 0.89)], couldn't read and write and completed primary education [AOR = 2.35, 95% CI (1.01, 5.43)] & [AOR = 2.92, 95% CI (1.39, 6.12)], living in rural area [AOR = 3.84, 95% CI (1.91, 7.75)], having diabetic complications [AOR = 2.19, 95% CI (1.07, 4.46)], taking both injection and pills [AOR = 0.33, 95% CI (0.12, 0.88)], having previous information about foot care [AOR = 0.12, 95% CI (0.06, 0.24)], and family support [AOR = 0.57, 95% CI (0.34, 0.94)] were determinants of poor foot self-care practice.

CONCLUSION

The adherence of diabetic patients toward foot self-care practice was poor. Being male, having low educational status, living in a rural area, having diabetic-related complications, taking both injections and pills, not having previous information about foot care, and having poor family support increases the odds of having poor foot self-care practice. Giving health education to patients and their caregivers about the basic principles of diabetes foot care, like regular inspection of feet and appropriate footwear at their regular follow-up time, should be emphasized.

Behaviour change approaches for individuals with diabetes to improve foot self-management: a scoping review

BACKGROUND

Diabetes related foot complications are increasing in complexity, frequency and cost. The application of self-management strategies can reduce the risk of individuals developing foot complications. The type, range and nature of the literature focusing on interventions that support patients with diabetic foot self-management is unknown. This scoping review aimed to i) identify self-management actions and risky behaviour avoidance strategies within interventions, ii) map the theoretical functions through which these behaviour change interventions have an effect, iii) display gaps in the research.

METHODOLOGY

Arksey and Malley's (2003) 5 stage framework was followed to conduct the scoping study. This methodological framework was selected because it was developed specifically for scoping reviews and therefore offered clear methodological distinction from systematic review methodology. . Databases were searched from inception of the project until June 2020 supplemented by hand searching of reference lists. In total 988 papers were identified. These were independently screened by three reviewers, identifying 19 eligible papers. Data extraction and charting of data was independently conducted by three reviewers to identify study characteristics, self-management actions and risky behaviours. Data was charted against the COM-B (capability, opportunity, motivation, behaviour) model of behaviour to determine intervention function.

RESULTS

In total 25 different foot self-management actions and risk behaviours were classified into three themes; routine self-management, trauma avoidance and warning signs and actions. Inspect feet daily received the most attention. The majority of interventions focused on knowledge and skills, but overlooked taking action and decision making. Intervention mapping identified four primary intervention functions (education, persuasion, training and enablement) used to address deficits in capability, opportunity and motivation that positively improved foot self-management behaviour. No studies targeted first ulcer prevention, and most either did not measure or improve foot health outcomes.

CONCLUSION

This review charted the evidence for interventions promoting diabetic foot self-management through a theoretical behaviour change perspective. A core set of behaviour change activities and intervention functions associated with positive changes in behaviour were identified. This information will provide researchers with a useful basis for developing self-management interventions.

Prevalence and predictors of anxiety and depressive symptoms among patients diagnosed with oral cancer in China: a cross-sectional study

BACKGROUND

Anxiety and depression are common mental health problems among patients with cancer. While many psychological variables have been proven to influence anxiety and depressive symptoms, the variables are not mutually exclusive and their integrated effects on patients with oral cancer are yet unknown. The present study aims to explore the prevalence of anxiety and depressive symptoms among patients with oral cancer, to find out key potentially predictive factors associated with anxiety and depressive symptoms.

METHOD

A cross-sectional study was carried out for Chinese patients with oral cancer between May 2016 and October 2017 in two Grade-A Tertiary Hospitals in Shenyang, China. Two hundred thirty patients with oral cancer were interviewed with questionnaires on demographic variables, Zung Self-Rating Anxiety Scale (SAS), Center for Epidemiologic Studies Depression Scale (CES-D), Herth Hope Index (HHI), Social Impact Scale, Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test (LOT-R), Perceived Stress Scale-10 (PSS-10), and General Perceived Self-efficacy Scale(GSE). Chi-square test, nonparametric test, t-test and logistic regression analyses were conducted where appropriate to explore predictive factors of anxiety symptoms and depressive symptoms.

RESULTS

The prevalence of anxiety symptoms and depressive symptoms in the sample population was 36.96% (85/230) and 65.21% (150/230), respectively. Social isolation dimension of stigma (β = 0.436, OR = 1.547, CI:1.211 ~ 1.975), optimism (β = - 0.276, OR = 0.759, CI:0.624 ~ 0.922), and perceived stress (β = 0.217, OR = 1.243, CI:1.092 ~ 1.414) were predictors of anxiety symptoms. Marriage (β = 1.648, OR = 5.198, CI:1.427 ~ 18.924), positive readiness and expectancy dimension of hope (β = - 0.505, OR = 0.604, CI:0.395 ~ 0.923), social isolation dimension of stigma (β = 0.314, OR = 1.368, CI:1.054 ~ 1.776) and perceived stress (β = 0.273, OR = 1.314, CI:1.134 ~ 1.524) were predictors of depressive symptoms among oral cancer patients.

CONCLUSION

The prevalence of anxiety symptoms and depressive symptoms was high among oral cancer patients in China. The communal predictors of anxiety and depressive symptoms in patients with oral cancer were levels of perceived stress and social isolation of stigma. In addition, optimism was a predictor of anxiety symptoms and hope was a predictor of depressive symptoms.

TRIAL REGISTRATION

2015-16, registered 20 Dec 2015.

Associations Between Racial and Ethnic Groups and Foot Self-Inspection in People With Diabetes

OBJECTIVE

Daily foot self-inspection may permit earlier detection and treatment of a foot lesion, reducing the risk of infection and lower-limb amputation (LLA). Though race and ethnicity are strongly associated with LLA risk, with higher risk seen in African Americans (AA), American Indians/Alaska Natives (AI/AN), and Native Hawaiians/Pacific Islanders (NH/PI), associations between foot self-inspection and racial and ethnic groups are inconsistent. We aimed to assess differences in foot self-inspection among people with diabetes by race/ethnicity.

RESEARCH DESIGN AND METHODS

Using national, cross-sectional data from the 2015-2017 Behavioral Risk Factor Surveillance System surveys and including 88,424 individuals with diabetes, we estimated prevalence ratios (PRs) and associated 95% CIs of daily foot checking for sores or irritation by racial and ethnic groups using log-binomial linear regression models, after accounting for survey weights.

RESULTS

Compared with whites (who had a weighted prevalence [P] of daily foot self-inspection of 57%), AA (P 67%, PR 1.18 [95% CI 1.14, 1.23]), AI/AN (P 66%, PR 1.15 [95% CI 1.07, 1.25]), and NH/PI (P 71%, PR 1.25 [95% CI 1.03, 1.52]) had higher prevalences of daily foot self-inspection. The prevalence of daily foot inspection was significantly lower among Asians (P 35%, PR 0.62 [95% CI 0.48, 0.81]) and Hispanics (P 53%, PR 0.93 [95% CI 0.88, 0.99]) compared with whites. Associations did not vary importantly by insulin use, years since diabetes diagnosis, or having received diabetes self-management education.

CONCLUSIONS

The higher frequency of foot self-inspection in racial and ethnic groups at elevated risk of diabetes-related LLA is not sufficient to eliminate LLA disparities; additional interventions are needed to achieve this aim.

Foot self-care behavior and its predictors in diabetic patients in Indonesia

OBJECTIVES

Previous studies have shown that diabetic foot ulcers are principally associated with improper foot self-care. Since appropriate foot self-care is essential to prevent diabetic foot-ulcers, any factors which can predict foot self-care behavior should be identified. However, until now, foot self-care behavior data and predictors of foot-care behavior in Indonesia remain unclear since such studies on Indonesian diabetic patients is very limited. Therefore, the purpose of this study was to investigate foot self-care behavior and to identify its predictors in Indonesia. The design of this study was cross-sectional. Cluster sampling was used, involving 546 type 2 diabetes mellitus patients registered in 22 primary healthcare centers. The questionnaires used in this study included the Diabetes Distress Scale, Beck Depression Inventory II, Family APGAR, Foot-Care Knowledge and Modified Diabetic Foot Care Behaviors.

RESULTS

Foot self-care behavior and knowledge about foot care were poor. The predictors of foot self-care behavior were age, educational level, diabetes distress, family support, and knowledge. It needs the program to improve foot self-care knowledge and the program to reduce the diabetes distress in Indonesian diabetic patients. In performing of these programs, families should be involved to improve the support toward foot self-care behavior in patients.

The moderating effect of social support on the relationship between physical health and suicidal thoughts among Chinese rural elderly: A nursing home sample

Suicide rate is relatively high among Chinese rural elderly. While there has been some exciting work on reporting and preventing suicide among community-dwelling elderly, only a few published studies have addressed the issues of rural nursing homes in China. This study aimed to investigate the relationship among perceived social support, physical health, and suicidal thoughts of the elderly living in Chinese rural nursing homes. It also examined the moderating effects of social support on the path from physical health to suicidal thoughts of the rural institutional elderly in China. This study investigated 205 participants aged 60 years and above in Chinese rural nursing homes. Participants' suicidal thoughts, perceived social support, and physical health were assessed. This study conducted descriptive analysis, Student's t-test, and Pearson's chi-square test to test how physical health and social support predicted suicidal thoughts, as well as the moderating effects of family's, friends', and others' social support on physical health and suicidal thoughts. Both physical health and perceived social support were significantly related to suicidal thoughts. Perceived social support from family, friends, and significant others moderated the relationship between physical health and suicidal thoughts. Findings of this study suggested that increasing social support and improving physical health would be effective in both suicide prevention and intervention for the residents in Chinese rural nursing homes.

'Why should I worry, since I have healthy feet?' A qualitative study exploring barriers to use of footwear among rural community members in northern Ethiopia

OBJECTIVE

To explore the influence of personal, cultural and socioeconomic factors related to footwear use and non-use in northern Ethiopia.

DESIGN

A qualitative study was conducted using focus group discussions and in-depth individual interviews. Data were collected using semistructured interview guides.

SETTING

The study was conducted in East and West Gojjam Zones, Amhara region, northwest Ethiopia.

PARTICIPANTS

A total of 91 individuals from 4 target groups participated in individual and group interviews: (1) non-affected community leaders including Idir (a form of social insurance) leaders, school principals, kebele (the lowest administrative unit) officials, health professionals, teachers, merchants and religious leaders; (2) affected men and women; (3) non-affected men and women not in leadership positions; and (4) school children (both male and female).

RESULTS

Participants perceived a range of health benefits from donning footwear, including protection against injury and cold. Various types of shoes are available within the community, and their use varied depending on the nature of activities and the season. Personal and socioeconomic barriers hindered the desire to consistently use footwear. Widely established barefoot traditions and beliefs that footwear is uncomfortable, heavy and may weaken the feet have made the regular use of footwear uncommon. Economic constraints were also mentioned as hindering ownership and use of footwear. Distance from places where shoes could be bought also contributed to limited access. Cultural influences promoting gender inequality resulted in women being least able to access shoes.

CONCLUSIONS

We identified several individual, cultural and socioeconomic barriers that influence individuals' decisions about and use of footwear in rural northern Ethiopia. Promoting education on the health benefits of footwear, curbing podoconiosis-related misconceptions and integrating these with economic empowerment programmes, may all improve the use of footwear.

Type 2 diabetes-related foot care knowledge and foot self-care practice interventions in the United States: a systematic review of the literature

Introduction

The purpose of this systematic literature review is to review published studies on foot care knowledge and foot care practice interventions as part of diabetic foot care self-management interventions.

Methods

Medline, CINAHL, CENTRAL, and Cochrane Central Register of Controlled Trials databases were searched. References from the included studies were reviewed to identify any missing studies that could be included. Only foot care knowledge and foot care practice intervention studies that focused on the person living with type 2 diabetes were included in this review. Author, study design, sample, intervention, and results were extracted.

Results

Thirty studies met the inclusion criteria and were classified according to randomized controlled trial (n=9), survey design (n=13), cohort studies (n=4), cross-sectional studies (n=2), qualitative studies (n=2), and case series (n=1). Improving lower extremity complications associated with type 2 diabetes can be done through effective foot care interventions that include foot care knowledge and foot care practices.

Conclusion

Preventing these complications, understanding the risk factors, and having the ability to manage complications outside of the clinical encounter is an important part of a diabetes foot self-care management program. Interventions and research studies that aim to reduce lower extremity complications are still lacking. Further research is needed to test foot care interventions across multiple populations and geographic locations.

Determine the relationship between perceived social support and depression level of patients with diabetic foot

Background

As a lifelong disease, diabetes impairs the quality of life by limiting the eating and drinking habits and by bringing out the risk of kidney, eye, cardiovascular and diabetic neurological diseases in the long run. Loss of health might result in mourning, grief, rebellion, denial, anxiety, rage and sometimes these feelings might overcome the patient’s coping skills leading to depression [Clinical Psychiatry 11 (Suppl 3) 3-18, 2008]. How individuals suffering from depression perceive and interpret the incidents around them is also important [Rel. Scie. Acad. J. III, 2: 129-152, 2003]. Accordingly, the determination of the correlation of the depression with the perceived social support level by the patients with diabetic foot was programmed and performed in order to take essential precautions, to generate proper solutions and treatment process and to make supportive plans for patients with developing diabetic foot and depression.

Methods

The data was obtained from 128 patients who applied to hospital within the scope of research between July 1st 2011 and January 31st 2012 that were diagnosed with diabetes and had diabetic foot. Pearson chi-square, Fisher Exact and Likelihood ratio, chi-square, Student t test and one way analysis of variance, Levene’ s test, One way ANOVA, Welch and Games Howell tests were used in the analysis and evaluation. The data was collected by meeting face to face the individuals and by making use of the patient files and using the “Personal Information Form” which includes introductory information about individuals with diabetic foot, “Beck Depression Scale” which is applied to determine emotion status of individuals and “Multidimensional Scale of Perceived Social Support” which is applied to determine the level of social support individuals perceive.

Results

In the performed statistical evaluation, mean scores of Beck Depression scale and MSPSS family support, friend support, special person support sub-dimension and scale total scores were found to be in negative statistical correlation (p < 0.01).

Conclusions

In the treatment and care of the patients with diabetic foot; anxiety and depression status of the patients, as well as physical status, should also be evaluated routinely. The individuals provided to take professional care.

Who cares about foot care? Barriers and enablers of foot self-care practices among non-institutionalized older adults diagnosed with diabetes: an integrative review

PURPOSE

Appropriate and timely foot self-care practices may prevent diabetes-related foot complications. However, self-care practices are often neglected, particularly by older adults. The purpose of this study was to conduct an integrative, systematic literature review of the psychosocial barriers and enablers of foot self-care practices among older adults diagnosed with diabetes.

METHODS

An integrative, systematic literature review and a deductive thematic analysis was conducted to determine psychosocial barriers and enablers of foot self-care practices among older adults.

RESULTS

A total of 130 different studies were retrieved from the search strategy. From these, 9 studies were identified and included for review. Physical ability, perceived importance, patient knowledge, provision of education, social integration, risk status, and patient-provider communication were identified as key barriers and enablers of foot self-care. Participants at high risk of foot complications were found to perceive themselves at greater risk of complications, receive more education, and engage in better overall foot self-care practices compared to those at low risk of foot complications.

CONCLUSION

Foot self-care practices appear underutilized as primary prevention measures by older adults and are instead adopted only once complications have already occurred. Likewise, facilitators of foot self-care practices, such as education, appear to be reserved for individuals who have already developed foot complications. Health care professionals such as diabetes educators, podiatrists, and general practitioners may play an important role in the prevention of foot complications among older adults by recognizing, referring, and providing early education to older adults.

A qualitative study exploring barriers related to use of footwear in rural highland ethiopia: implications for neglected tropical disease control

Background

The role of footwear in protection against a range of Neglected Tropical Diseases (NTDs) is gaining increasing attention. Better understanding of the behaviors that influence use of footwear will lead to improved ability to measure shoe use and will be important for those implementing footwear programs.

Methodology/Principal Findings

Using the PRECEDE-PROCEED model we assessed social, behavioral, environmental, educational and ecological needs influencing whether and when children wear shoes in a rural highland Ethiopian community endemic for podoconiosis. Information was gathered from 242 respondents using focus groups, semi-structured interviews and extended case studies. Shoe-wearing norms were said to be changing, with going barefoot increasingly seen as ‘shameful’. Shoes were thought to confer dignity as well as protection against injury and cold. However, many practical and social barriers prevented the desire to wear shoes from being translated into practice. Limited financial resources meant that people were neither able to purchase more than one pair of shoes to ensure their longevity nor afford shoes of the preferred quality. As a result of this limited access, shoes were typically preserved for special occasions and might not be provided for children until they reached a certain age. While some barriers (for example fit of shoe and fear of labeling through use of a certain type of shoe) may be applicable only to certain diseases, underlying structural level barriers related to poverty (for example price, quality, unsuitability for daily activities and low risk perception) are likely to be relevant to a range of NTDs.

Conclusions/Significance

Using well established conceptual models of health behavior adoption, we identified several barriers to shoe wearing that are amenable to intervention and which we anticipate will be of benefit to those considering NTD prevention through shoe distribution.

Consistently wearing shoes may help in preventing onset or progression of a wide range of Neglected Tropical Diseases (NTDs). This study assessed the factors that influenced shoe wearing behaviors among people living in a rural community in highland Ethiopia. In this community, a substantial proportion of people are at risk for podoconiosis, a debilitating lower leg condition that can be prevented by wearing shoes. We conducted semi-structured individual interviews, focus group discussions and extended case studies among 242 adults and systematically analyzed the information. We found that shoe wearing is intermittent, and that different factors such as cost and ability to use the shoes for certain activities (such as farming) influenced consistent shoe wearing for most people. Some factors (such as shoe size, fear of stigma) were more relevant for podoconiosis patients. Social norms were found to be increasingly supportive of shoe wearing, and children exhibited greater desire to wear shoes than adults. These findings have relevance for preventing development and progression of a variety of NTDs in a range of settings.

Does incorporation of a clinical support template in the electronic medical record improve capture of wound care data in a cohort of veterans with diabetic foot ulcers?

PURPOSE

The purpose of this cohort study was to evaluate the effect of a 1-year intervention of an electronic medical record wound care template on the completeness of wound care documentation and medical coding compared to a similar time interval for the fiscal year preceding the intervention.

METHODS

From October 1, 2006, to September 30, 2007, a "good wound care" intervention was implemented at a rural Veterans Affairs facility to prevent amputations in veterans with diabetes and foot ulcers. The study protocol included a template with foot ulcer variables embedded in the electronic medical record to facilitate data collection, support clinical decision making, and improve ordering and medical coding.

RESULTS

The intervention group showed significant differences in complete documentation of good wound care compared to the historic control group (χ = 15.99, P < .001), complete documentation of coding for diagnoses and procedures (χ = 30.23, P < .001), and complete documentation of both good wound care and coding for diagnoses and procedures (χ = 14.96, P < .001).

CONCLUSIONS

An electronic wound care template improved documentation of evidence-based interventions and facilitated coding for wound complexity and procedures.

Facility-level variations in patient-reported footcare knowledge sufficiency: implications for diabetes performance measurement

AIMS

To evaluate medical center variation in self-reported knowledge of footcare practices by veterans at high risk for lower extremity complications.

METHODS

We utilized a previously validated footcare-specific survey from 772 (44% response rate) veterans with diabetes and high-risk foot conditions at eight Veterans Administration facilities that contained items on knowledge of basic (such as how to inspect feet) and specialized self-foot care practices (such as cutting nails and shaving calluses). Linear regression models were used to evaluate facility-level variation in unadjusted and adjusted education (controlling for age, schooling, general, and foot health).

RESULTS

Participants' average age was 67 years, 94% were male and 34% had 13 years of education. The mean facility basic knowledge score on a four-point ordinal scale was 3.1 (range: 2.9-3.3), where 1=no knowledge and 4=enough knowledge. The specialized knowledge score, using the same scale, was 2.52 (range: 2.2-2.8). There were significant (p<0.005) differences among facilities in both unadjusted and adjusted basic and specialized footcare knowledge.

CONCLUSIONS

Patient self-reported footcare knowledge was suboptimal and significantly varied across medical centers with and without adjustment for foot-risk factors, general health, and demographic factors.

Can the use of a topical antifungal nail lacquer reduce risk for diabetic foot ulceration? Results from a randomised controlled pilot study

The purpose of this study was to determine whether the routine use of a topical antifungal nail lacquer (AFL) could reduce the risk for ulceration by theoretically increasing the frequency of patient self-inspection. In this randomised controlled trial, 70 persons at high risk for diabetic foot ulceration were enrolled into a preventative care program involving daily self-inspection with the possible use of an AFL (ciclopirox 8%) versus self-inspection instructions alone (NAFL). Patients were followed for 12 months or until ulceration. Using an intent to treat analysis, there was no significant difference in proportion of persons ulcerating in the AFL versus the NAFL groups (5.9% versus 5.6% P = 0.9). There was also no difference in the number of unexpected visits (P = 0.2) or missed appointments (P = 0.7) between treatment arms. Interestingly, while there was no difference in proportion of patients with clinically diagnosed hyperkeratosis or tinea pedis on entry into the study (P = 0.2), a significantly lower proportion of AFL patients had a clinical diagnosis on study termination (52.9% versus 77.8% P = 0.03, OR = 1.7, 95% confidence interval = 1.1-2.7). The results of this study suggest that there may be no immediate prophylactic benefit through the use of AFL to prevent wounds. The incidental finding of a potential reduction in hyperkeratosis and tinea pedis is a compelling one and may deserve further investigation.

A case-control study of the risk factors for toe amputation in a diabetic population

Toe amputations are becoming more prevalent in the diabetic population. To prevent toe amputations, those individuals with the highest risk must be identified prior to developing a precipitating event. There are obvious risk factors for toe amputations, such as digital deformity, diabetic neuropathy, and ischemia. Other, less obvious, systemic comorbidities may be linked to toe amputations. This study also shows that gender plays a significant role as a risk factor for toe amputation. A foot infection, foot abscess, osteomyelitis, diabetic retinopathy, and diabetic nephropathy were also significant risk factors for toe amputations. This suggests a significant relationship between these complications and comorbidities that put these individuals at a higher risk for toe amputations.

A clinical study and the National Service Framework for diabetes

Clinical assessment and management for anyone who has diabetes may be influenced by the development of the National Service Framework (NSF) for Diabetes. Through a case study, this article explains how the NSF for Diabetes and other recent NHS documentation has influenced our approach to managing a type 2 diabetic patient whose feet are categorised as 'high risk'. Some of the potential shortfalls of the NSF for Diabetes are also discussed in this context.

Incorporating foot care education into diabetic foot screening

Rehabilitation nurses care for patients with diabetes who have strokes, orthopedic surgery, and spinal cord injuries; therefore, they should be knowledgeable about foot screening technique and foot care education so that they can identify patients who are at risk for foot skin breakdown. The objectives of diabetic foot screening are to identify foot problems, determine a foot risk category and management category for patients, and to instruct patients with diabetes and their families in proper foot care. The screening technique is simple and can be used in clinic settings or at the bedside. Incorporating foot care education into the foot screening process increases or reinforces patients' knowledge of self-care. Such knowledge empowers patients to join with their healthcare teams to decrease the incidence of ulceration and amputation.