Level of and factors associated with foot self-care among people with diabetes in Idlib Province of Northwest Syria: A cross-sectional study

Background and aims

Diabetic foot and lower limb problems are among the most neglected complications during the Syrian armed conflict due to the absence of a functioning health infrastructure, including early detection and timely management of limb-threatening wounds. This study aimed to determine self-reported diabetes-related foot disease (DRFD), adherence to recommended foot self-care (FSC) practices, and associated factors among people with diabetes in war-torn Northwest Syria (NWS).

Methods

This was a cross-sectional study conducted at six primary care clinics in Idlib, NWS, between March 27 and April 17, 2022, utilizing the validated interviewer-administered Diabetes Foot Disease and Foot Care Questionnaire. Data on demographic characteristics, DRFD, and FSC practices were collected. FSC score was determined by adding the points from all 12 FSC items, with a maximum score of 48, and were categorized into very poor (≤12), poor (13-24), moderate (25-36), and good (37-48). A convenience sample of 331 consecutive Syrians, aged ≥18 years, with diabetes, were invited. Multiple linear regression was used to identify variables associated with FSC practices.

Results

A total of 328 patients completed the questionnaire (response rate: 99.1%). The overall FSC score was average (mean total score 27.24, SD 7.03). Over one-third (37.8%) had a very poor/poor score, 50.3% had an average score, and 11.9% had a good score. Household income/month of ≥51 USD (β = 2.6, 95% confidence interval [95% CI]:1.06-4.1, p = 0.001) and diabetes duration of ≥10 years (β = 1.8, 95% Cl: 0.2-3.4, p = 0.027) significantly predicted better FSC practice.

Conclusion

A significant proportion of participants had inadequate adoption FSC behaviors. Higher socioeconomic status was associated with better FSC practices. Future research should evaluate diabetic foot education and professional foot care in this population.

Patient and health care provider knowledge of diabetes and diabetic microvascular complications: a comprehensive literature review

Diabetic retinopathy, neuropathy, and nephropathy occur in more than 50% of people with diabetes, contributing substantially to morbidity and mortality. Patient understanding of these microvascular complications is essential to ensure early recognition and treatment of these sequalae as well as associated symptoms, yet little is known about patient knowledge of microvascular sequalae. In this comprehensive literature review, we provide an overview of existing knowledge regarding patient knowledge of diabetes, retinopathy, neuropathy, and nephropathy. We also discuss health care provider's knowledge of these sequalae given that patients and providers must work together to achieve optimal care. We evaluated 281 articles on patient and provider knowledge of diabetic retinopathy, neuropathy, and nephropathy as well as predictors of improved knowledge and screening practices. Results demonstrated that patient and provider knowledge of microvascular sequalae varied widely between studies, which may reflect sociocultural or methodologic differences. Knowledge assessment instruments varied between studies with limited validation data and few studies controlled for confounding. Generally, improved patient knowledge was associated with greater formal education, longer diabetes duration, and higher socioeconomic status. Fewer studies examined provider knowledge of sequalae, yet these studies identified multiple misconceptions regarding appropriate screening practices for microvascular complications and the need to screen patients who are asymptomatic. Further investigations are needed that use well validated measures, control for confounding, and include diverse populations. Such studies will allow identification of patients and providers who would benefit from interventions to improve knowledge of microvascular complications and, ultimately, improve patient outcomes.

Factors Associated With Foot Self-Care in Patients With Diabetes-Related High-Risk Feet: A Cross-Sectional Design

Foot self-care has been commonly studied among people with diabetes. Previous research on foot self-care among those with diabetes-related high-risk feet is almost unavailable or very limited. The current study aims to fill this gap and provide a contemporary unprecedented analysis of this area of specialization. To assess the levels of, and factors associated with foot self-care among people with diabetes-related high-risk feet. A multi-center cross-sectional study from Jordan assessed the foot self-care of 107 participants with diabetes-related high-risk feet. Multiple socio-demographic, physiological, and psychosocial factors were collected, and the Arabic version of the diabetes foot self-care behavior scale was used to estimate the foot self-care of the study population. A multiple linear regression model was employed to identify factors associated with foot self-care. The mean score of foot self-care was 25.4 ± 7.1 (35 is the highest) indicating ~73% of adherence to foot self-care. Factors associated with higher foot self-care were being treated at the King Abdullah University Hospital (β = .30, P < .01) and reporting higher scores of patients' interpretations about neuropathy physical causes of foot ulcers (β = ".22," P = .02). People with diabetes-related high-risk feet reported a relatively adequate foot self-care practice. However, clinicians are still required to enhance foot self-care among this population. Health promotion programs may benefit from engaging people in understanding the pathophysiology of diabetes-related foot ulcers to improve foot self-care practices.

Practice and associated factors regarding foot care among diabetes mellitus patients attending a rural primary health center in South India

Background:

Diabetes mellitus patients are more likely to undergo nontraumatic foot or leg amputations because they have decreased circulation to the feet or reduced sensation. This condition may cause ulcerations, infections, and delayed wound healing, leading to amputations. Adequate knowledge and practices regarding foot care will be vital in the prevention of diabetic foot complications. Hence, this study aimed to determine the level of knowledge and practices of foot care among diabetes mellitus patients attending a rural primary health center in Belagavi-South India.

Materials and Methods:

A cross-sectional study was conducted in the rural field practice area of J.N. Medical College, Belagavi, for 7 months (November 2019 to May 2020). A pretested questionnaire was administered to 461 diabetes patients attending the health center. A written informed consent was obtained from each participant. They were interviewed with a questionnaire consisting of 15 “yes” or “no” questions, each on foot care knowledge and practice.

Results:

The mean age of the study participants was 50.28 ± 9.48 years. The mean duration of diabetes was 10.69 ± 7.09 years. Majority, i.e., 296 (64.2%) participants showed satisfactory knowledge and 293 (63.6%) showed satisfactory practice. Only 97 (21%) had poor knowledge, 90 (19.5%) had poor practice, 68 (14.8%) patients had good knowledge, and 78 (16.9%) had good practice about diabetic foot care.

Conclusions:

The low level of knowledge and practice in patients with diabetes regarding foot care necessitates an educational program to increase awareness related to foot complications of diabetes, thereby motivating diabetic patients to incorporate foot care practices in their day-to-day routine.

Cross-Cultural Adaptation and Reliability Testing of Arabic Versions of Several Diabetic Foot Psychosocial Scales

The main aims of this study were cross-cultural adaptation and reliability testing of an Arabic version of Foot Care Confidence Scale (FCCS), Foot Care Outcomes Expectations Scale (FCOES), Patient Interpretation of Neuropathy Scales (PINS), Neuropathy-specific Quality of Life Scales (NQOLS), and offloading-related Visual Analog Scales (VAS). Two phases of translation and reliability testing were conducted in Jordan. Phase 1 included 2 forward and backward translations with 2 panel consensuses (translators, clinicians, and experts). In Phase 2, Cronbach's alpha (α) and intraclass correlation coefficient (ICC) were used to test the internal consistency and stability (test-retest) of the Arabic scales in a sample of a total of 90 Jordanian participants with diabetic foot ulcers. Phase 1 resulted in Arabic translation and cross-cultural adaptation of the study scales. Phase 2 resulted in acceptable internal consistency of the translated scales (α = 0.74-0.91), except for the PIN "self/practitioner blame" and "acute ulcer onset" scales (α = 0.57, 0.49, respectively). Test-retest results (ICC) were: FCCS (0.85); FCOES (0.78); PINS (0.043-0.85); NQOLS (0.76-0.90); and offloading-related VAS (0.43-0.90). This study showed evidence of cultural appropriateness and reliability of most of the translated scales, for possible future implementation for the Arabic population.

Knowledge and practice of diabetic foot care - A scoping review

BACKGROUND AND AIMS

This review aims to systematically map global evidence on foot-care knowledge and practices in relation to diabetes mellitus (DM) and identify areas that need further research.

METHODS

Database searches were undertaken using Google Scholar, Medline (PubMed), Academic Search Complete (EBSCOhost), and Medline (EBSCOhost). Studies were initially sought by title and focused on knowledge of diabetic foot ulcer burden. The framework by Arksey and O'Malley and the PRISMA-SCR guidelines were used to guide the methodology. The themes explored were principles of foot-care knowledge and practice and these were reported using content analysis. The mixed-methods appraisal tool (MMAT) was employed to appraise the quality of the primary studies.

RESULTS

Fifty-eight studies published between 2008 and 2018 met the inclusion criteria. Participants in various studies had varying degrees of foot-care knowledge and practice, including foot inspection, foot hygiene, glycaemic control, and foot protection. Many people had knowledge of the various aspects of foot care but fewer practiced proper foot care. The MMAT showed the majority of the articles to be of high quality.

CONCLUSIONS

Level of foot-care knowledge and practice varied in the studies. A need for intervention on foot care was highlighted.

Knowledge, attitude, and practice regarding diabetic foot care among Saudi and non-Saudi diabetic patients in Alkharj

Context

There is a high prevalence of diabetes mellitus in Saudi Arabia. Also, the diabetic foot complication rate is alarmingly high with many patients ending in amputation.

Aims

To assess the knowledge, attitude, and practices regarding diabetic foot care among Saudi and non-Saudi diabetic patients in Alkharj.

Settings and Design

It is a cross-sectional study conducted from May 22^nd, 2019 to April 1^st, 2020 at Diabetic clinic, Military Hospital in Alkharj.

Methods and Materials

Non-randomized, non-probability convenience sampling technique was used to collect data from 224 patients by using a validated and confidential questionnaire in either face-to-face interviews or as an electronic survey. All adult patients over 18 years of age of both sexes having type 1 and 2 diabetes mellitus were included. The patients who were unable to provide the requested information were excluded.

Statistical Analysis

The data were analyzed using SPSS version 24.

Results

The mean age of patients was 49.37 years with 58.5% male and 41.5% female patients. About 58% of patients had diabetes for more than 10 years. More than half of the patients reported some foot problems, while 9.4% have had active or healed ulcerations. The mean scores for knowledge, attitude, and practice were 8.576, 4, and 13, respectively, all statistically significant.

Conclusions

Our study population has sufficient knowledge about diabetes and its foot complication, and they also had a positive attitude towards its management. However, they were lagging in the practices required for diabetic foot management.

Development and Pilot Testing of a Diabetes Foot Care and Complications Questionnaire for Adults with Diabetes in Oman: The Diabetic Foot Disease and Foot Care Questionnaire

Objectives

Diabetic foot disease causes substantial morbidity and mortality, but it can be prevented. Our study examined the frequency of diabetes-related foot problems and foot self-care practices, as reported by consecutive patients attending primary and secondary diabetes services in Muscat, Oman.

Methods

A cross-sectional survey utilizing a newly developed and pre-tested questionnaire was conducted at eight primary health care centers and one polyclinic (secondary care) in A'Seeb, Muscat. A convenience sample of 353 consecutive Omanis, aged 20 years and above, diagnosed with diabetes were invited to participate in this study. We collected data on clinico-demographic characteristics, patient-reported foot complications, and foot self-care practices.

Results

Of the 350 patients who agreed to participate (mean diabetes duration 7.9±7.4 years, response rate: 99.2%), 62.3% were female, 57.4% were unemployed, more than half were illiterate (52.9%), and around three-quarters (71.4%) were unsure of the type of diabetes they had. More than half (55.1%) reported having at least one or more sensory peripheral neuropathy symptoms, almost half (49.1%) reported one or more peripheral vascular disease symptoms in the previous month, and 12.5% a history of foot ulceration. Reported foot self-care practices were overall suboptimal; 54.7% did not examine the bottom of their feet each day.

Conclusions

Although self-reported diabetes-related foot complications were common in this population, foot self-care practices were inadequate. These findings suggest a need for the provision of regular foot care education to patients with diabetes. Future research should explore barriers to recommended foot self-care practices.

Associations of health literacy with diabetic foot outcomes: a systematic review and meta-analysis

BACKGROUND

People with diabetes have low health literacy, but the role of the latter in diabetic foot disease is unclear.

AIM

To determine, through a systematic review and meta-analysis, if health literacy is associated with diabetic foot disease, its risk factors, or foot care.

METHODS

We searched PubMed, EMBASE, CINAHL, Web of Science, Scopus and Science Direct. All studies were screened and data extracted by two independent reviewers. Studies in English with valid and reliable measures of health literacy and published tests of association were included. Data were extracted on the associations between the outcomes and health literacy. Meta-analyses were performed using random effects models.

RESULTS

Sixteen articles were included in the systematic review, with 11 in the meta-analysis. In people with inadequate health literacy, the odds of having diabetic foot disease were twice those in people with adequate health literacy, but this was not statistically significant [odds ratio 1.99 (95% CI 0.83, 4.78); two studies in 1278 participants]. There was no statistically significant difference in health literacy levels between people with and without peripheral neuropathy [standardized mean difference -0.14 (95% CI -0.47, 0.18); two studies in 399 participants]. There was no association between health literacy and foot care [correlation coefficient 0.01 (95% CI -0.07, 0.10); seven studies in 1033 participants].

CONCLUSIONS

There were insufficient data to exclude associations between health literacy and diabetic foot disease and its risk factors, but health literacy appears unlikely to have a role in foot care. The contribution of low health literacy to diabetic foot disease requires definitive assessment through robust longitudinal studies.