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Effects of Diabetic Foot Care Education for the Aged with Low Health Literacy

Article information

Res Community Public Health Nurs. 2019;30(4):560-570
Publication date (electronic) : 2019 December 12
doi : https://doi.org/10.12799/jkachn.2019.30.4.560
Hyemin Kim1, Ji Min Seo,2
1Nurse, Pusan National University Yangsan Hospital, Yangsan, Korea
2Professor, College of Nursing, Pusan National University, Yangsan, Korea
Corresponding author: Seo, Ji Min College of Nursing, Pusan National University, 49 Pusandaehak-ro, Mulgeum-eup, Yangsan 50612, Korea. Tel: +82-51-510-8351, Fax: +82-51-510-8308, E-mail: seojimin@pusan.ac.kr
Received 2019 July 10; Revised 2019 November 11; Accepted 2019 November 17.

Abstract

Abstract

Purpose

The purpose of this study was to examine the effects of diabetic foot care education for the older adults with low health literacy.

Methods

A quasi-experimental design with a non-equivalent control group pretest-posttest was used. The participants who were diagnosed with diabetes, were adults over 65 years old at the welfare center of Y and B city. They were divided into the experimental group (n=32) and the control group (n=31). Inclusion criteria were a score of 5 or under on the Short form of Korean Functional Health Literacy Test and 24 or more on the Korean version of Mini-Mental State Examination. Foot care education was conducted in a small group for 40 minutes, once a week, for three weeks. The education materials are composed of an easy term, picture and photographs to understand easily.

Results

The scores of diabetic foot care knowledge (t=4.57, p<.001), foot care self-efficacy (t=6.07, p<.001), and foot self-care behavior (t=4.18, p<.001) were significantly increased in the experimental group compared to the control group. Foot health status was not significantly improved.

Conclusion

The findings indicate that this education program can be used as a nursing intervention improving foot care knowledge, foot care self-efficacy, and foot self-care behavior in order to prevent the diabetic foot problems of elderly diabetic persons with low health literacy.

Keywords: Aged; Diabetic foot; Foot ulcer; Diabetes mellitus; Health education

Foot Care Education for the Aged with Low Health Literacy

Homogeneity Test of Characteristics and Dependent Variables between Experimental and Control Group (N=63)

Comparison of Program Effects between Experimental and Control Group (N=63)

Comparison of Program Effects on Diabetic Foot Health Status between Experimental and Control Group (N=63)

References

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Copyright © 2019 Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Table 1.

Foot Care Education for the Aged with Low Health Literacy

Session Topic Content Method Time (minute)
1 Diabetes mellitus 1. Introduction to the program Lecture 40
2. What is Diabetes Mellitus? Demonstration
3. What is Insulin?
4. Glucose
5. Diabetic complications
6. Diabetes management
7. Questions and answers
2 Diabetic foot care I 1. Diabetic foot ulcer Lecture 40
2. Foot care necessity Demonstration
3. Foot observation method
4. Foot care method
5. When you need to visit a hospital
6. Questions and answers
3 Diabetic foot care II 1. Foot massage Demonstration 40
2. Foot exercise Training
3. Questions and answers

Table 2.

Homogeneity Test of Characteristics and Dependent Variables between Experimental and Control Group (N=63)

Characteristics Categories Exp. (n=32)
 Cont. (n=31)
 x2 or t p
n (%) or M±SD n (%) or M±SD
General characteristics Age (year) 65~69 7 (21.9) 2 (6.5) 6.08 .113†
70~74 9 (28.1) 6 (19.4)
75~79 11 (34.4) 11 (35.5)
≥80 5 (15.6) 12 (38.7)
Gender Male 2 (6.3) 7 (22.6) .082†
Female 30 (93.8) 24 (77.4)
Education ≤Middle school 17 (53.1) 12 (38.7) 1.49 .497†
High school 12 (37.5) 16 (51.6)
≥University 3 (9.4) 3 (9.7)
Disease related characteristics Duration of disease (year) ＜5 9 (28.1) 4 (12.9) 3.52 .340
5~9 5 (15.6) 9 (29.0)
10~14 8 (25.0) 6 (19.4)
≥15 10 (31.3) 12 (38.7)
Diabetic medication Yes 29 (90.6) 30 (96.8) .613†
No 3 (9.4) 1 (3.2)
Diabetic neuropathy Yes 1 (3.1) 1 (3.2) ＞.999†
No 31 (96.9) 30 (96.8)
History of diabetic foot Yes 0 (0.0) 1 (3.2) .492†
No 32 (100.0) 30 (96.8)
Dependent variables Diabetic foot knowledge 10.91±2.84 10.13±2.03 1.25 .218
Diabetic foot care self-efficacy 42.69±7.69 41.74±5.88 0.55 .586
Diabetic foot self-care behavior 44.28±6.75 46.68±6.20 1.47 .148
  6 point scale (9 items) 31.41±5.56 32.77±6.25 0.92 .362
  4 point scale (5 items) 12.88±2.30 13.90±1.83 1.96 .055
Foot health status
  Claw condition Normal 14 (43.8) 17 (54.8) 0.78 .379
Abnormal 18 (56.2) 14 (45.2)
  Skin condition Normal 21 (65.6) 22 (71.0) 0.21 .649
Abnormal 11 (34.4) 9 (29.0)
  Foot formation Normal 31 (96.9) 30 (96.8) ＞.999†
Abnormal 1 (3.1) 1 (3.2)
  Dorsal pedis artery Normal 32 (100.0) 31 (100.0) ＞.999†
  pulsation Abnormal 0 (0.0) 0 (0.0)
  Foot sense Normal 23 (71.9) 22 (71.0) 0.01 .936
Abnormal 9 (28.1) 9 (29.0)

Cont.=control group; Exp.=experiment group;

†

Fisher's exact test.

Table 3.

Comparison of Program Effects between Experimental and Control Group (N=63)

Variables Groups Pretest
 Posttest
 Difference
 t p
M±SD M±SD M±SD
Diabetic foot care knowledge Exp. (n=32) 10.91±2.84 14.38±1.29 3.47±3.06 4.57 ＜.001
Cont. (n=31) 10.13±2.03 10.74±2.13 0.61±1.75
Diabetic foot care self-efficacy Exp. (n=32) 42.69±7.69 54.78±6.18 12.09±9.78 6.07 ＜.001
Cont. (n=31) 41.74±5.88 41.87±4.93 0.13±5.26
Diabetic foot self-care behavior Exp. (n=32) 44.28±6.75 54.53±6.33 10.25±8.69 4.18 ＜.001
Cont. (n=31) 46.68±6.20 49.26±7.67 2.58±5.58
  6 point scale (9 items) Exp. (n=32) 31.41±5.56 37.34±5.45 5.94±7.83 2.56 .013
Cont. (n=31) 32.77±6.25 34.55±6.60 1.77±4.59
  4 point scale (5 items) Exp. (n=32) 12.88±2.30 17.19±2.72 4.31±3.22 4.37 ＜.001
Cont. (n=31) 13.90±1.83 14.71±2.91 0.81±3.15

Cont.=control group; Exp.=experiment group.

Table 4.

Comparison of Program Effects on Diabetic Foot Health Status between Experimental and Control Group (N=63)

Characteristics Categories Exp. (n=32)
 Cont. (n=31)
 x2 p
n (%) n (%)
Claw condition Normal 24 (75.0) 20 (64.5) 0.82 .365
Abnormal 8 (25.0) 11 (35.5)
Skin condition Normal 27 (84.4) 25 (80.6) 0.15 .697
Abnormal 5 (15.6) 6 (19.4)
Foot formation Normal 31 (96.9) 28 (90.3) .355†
Abnormal 1 (3.1) 3 (9.7)
Dorsal pedis artery Normal 32 (100.0) 31 (100.0) ＞.999†
Abnormal 0 (0.0) 0 (0.0)
Foot sense Normal 29 (90.6) 22 (71.0) .060†
Abnormal 3 (9.4) 9 (29.0)

Cont.=control group; Exp.=experiment group;

†

Fisher's exact test.