Factors Associated with Foot Self-care Behaviour and Foot Screening Attendance in People with Type 2 Diabetes: a Cross-sectional Study in Primary Care

Overview

Journal BMJ Open

Specialty General Medicine

Date 2024 Dec 31

PMID 39740946

Authors

Xiaoli Zhu

Silvana Tjhin

Ling Jia Goh

Jacqueline Giovanna de Roza

Frederick H F Chan

Ruoyu Yin

Eng Sing Lee

Konstadina Griva

Affiliations

Soon will be listed here.

Abstract

Objectives: To assess the factors associated with foot self-care behaviour and non-adherence to foot screening among patients with type 2 diabetes mellitus (T2DM).

Design And Setting: A multicentre cross-sectional study was undertaken in seven primary care polyclinics in Singapore between October 2020 and December 2021.

Participants And Outcomes: 275 adults (male 55.3%) with T2DM were included and assessed with the foot self-care behaviour questionnaire, including two aspects of foot care behaviour-preventative behaviour and potential damaging behaviour, and foot care confidence scale. Non-adherence to diabetic foot screening (DFS) attendance was also collected and assessed.

Results: The average preventive behaviour score was 0.65 (SD 0.13, range 0-1) and potential damaging behaviour score was 0.43 (SD 0.09, range 0-1). Patients with greater foot care confidence (β=0.272) and being married (β=0.141) were more likely to adopt preventive behaviours, while patients aged between 21 and 45 years (β=0.136), having shorter DM duration (<5 years) (β=0.142) and moderate foot risk category (β=0.138) were more likely to adopt potential damaging behaviours. Non-adherence to DFS attendance was prevalent up to 43.3%. Non-adherence was higher in patients with higher HbA1c ≥7% (adjusted OR (AOR) 1.878, 95% CI 1.090 to 3.235) and moderate foot risk category (AOR 2.935, 95% CI 1.426 to 7.744).

Conclusion: Self-efficacy and being married are associated with preventive behaviours, while clinical parameters (eg, HbA1c, duration of DM and foot risk category) and age were associated with potential damaging behaviours and non-adherence to DFS appointments. Longitudinal studies are needed to confirm the findings for developing foot behavioural education to support foot care behaviours for primary care patients with T2DM.

References

Pourhabibi N, Mohebbi B, Sadeghi R, Shakibazadeh E, Sanjari M, Tol A . Factors associated with treatment adherence to treatment among in patients with type 2 diabetes in Iran: A cross-sectional study. Front Public Health. 2022; 10:976888. PMC: 9667890. DOI: 10.3389/fpubh.2022.976888. View

Zhu X, Olsson M, Bajpai R, Lim V, Goh L . Factors Associated with Healing Outcomes in Primary Care Patients with Diabetic Foot Ulcers: A Retrospective Study in a Multiethnic Sample. Adv Skin Wound Care. 2021; 35(1):22-29. DOI: 10.1097/01.ASW.0000801524.42349.4d. View

Westby M, Norman G, Vedhara K, Game F, Cullum N . Psychosocial and behavioural prognostic factors for diabetic foot ulcer development and healing: a systematic review. Diabet Med. 2020; 37(8):1244-1255. DOI: 10.1111/dme.14310. View

Fitridge R, Chuter V, Mills J, Hinchliffe R, Azuma N, Behrendt C . The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes and a foot ulcer. Diabetes Metab Res Rev. 2023; 40(3):e3686. DOI: 10.1002/dmrr.3686. View

Bell R, Arcury T, Snively B, Smith S, Stafford J, Dohanish R . Diabetes foot self-care practices in a rural triethnic population. Diabetes Educ. 2005; 31(1):75-83. PMC: 1613259. DOI: 10.1177/0145721704272859. View

Bus S, Sacco I, Monteiro-Soares M, Raspovic A, Paton J, Rasmussen A . Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev. 2023; 40(3):e3651. DOI: 10.1002/dmrr.3651. View

Lan Nguyen T, Edwards H, Do T, Finlayson K . Effectiveness of a theory-based foot care education program (3STEPFUN) in improving foot self-care behaviours and foot risk factors for ulceration in people with type 2 diabetes. Diabetes Res Clin Pract. 2019; 152:29-38. DOI: 10.1016/j.diabres.2019.05.003. View

Alexandre K, Campbell J, Bugnon M, Henry C, Schaub C, Serex M . Factors influencing diabetes self-management in adults: an umbrella review of systematic reviews. JBI Evid Synth. 2021; 19(5):1003-1118. DOI: 10.11124/JBIES-20-00020. View

Karter A, Parker M, Moffet H, Ahmed A, Ferrara A, Liu J . Missed appointments and poor glycemic control: an opportunity to identify high-risk diabetic patients. Med Care. 2004; 42(2):110-5. DOI: 10.1097/01.mlr.0000109023.64650.73. View

10.

Vileikyte L, Gonzalez J, Leventhal H, Peyrot M, Rubin R, Garrow A . Patient Interpretation of Neuropathy (PIN) questionnaire: an instrument for assessment of cognitive and emotional factors associated with foot self-care. Diabetes Care. 2006; 29(12):2617-24. DOI: 10.2337/dc06-1550. View

11.

Riandini T, Pang D, Toh M, Tan C, Liu D, Choong A . Diabetes-related lower extremity complications in a multi-ethnic Asian population: a 10 year observational study in Singapore. Diabetologia. 2021; 64(7):1538-1549. PMC: 8187215. DOI: 10.1007/s00125-021-05441-3. View

12.

Perrin B, Swerissen H, Payne C . The association between foot-care self efficacy beliefs and actual foot-care behaviour in people with peripheral neuropathy: a cross-sectional study. J Foot Ankle Res. 2009; 2:3. PMC: 2650692. DOI: 10.1186/1757-1146-2-3. View

13.

Brewster S, Bartholomew J, Holt R, Price H . Non-attendance at diabetes outpatient appointments: a systematic review. Diabet Med. 2020; 37(9):1427-1442. DOI: 10.1111/dme.14241. View

14.

Karimy M, Koohestani H, Araban M . The association between attitude, self-efficacy, and social support and adherence to diabetes self-care behavior. Diabetol Metab Syndr. 2018; 10:86. PMC: 6260748. DOI: 10.1186/s13098-018-0386-6. View

15.

Apelqvist J, Bakker K, van Houtum W, Schaper N . Practical guidelines on the management and prevention of the diabetic foot: based upon the International Consensus on the Diabetic Foot (2007) Prepared by the International Working Group on the Diabetic Foot. Diabetes Metab Res Rev. 2008; 24 Suppl 1:S181-7. DOI: 10.1002/dmrr.848. View

16.

Goodall R, Ellauzi J, Tan M, Onida S, Davies A, Shalhoub J . A Systematic Review of the Impact of Foot Care Education on Self Efficacy and Self Care in Patients With Diabetes. Eur J Vasc Endovasc Surg. 2020; 60(2):282-292. DOI: 10.1016/j.ejvs.2020.03.053. View

17.

McInnes A, Jeffcoate W, Vileikyte L, Game F, Lucas K, Higson N . Foot care education in patients with diabetes at low risk of complications: a consensus statement. Diabet Med. 2011; 28(2):162-7. PMC: 3040291. DOI: 10.1111/j.1464-5491.2010.03206.x. View

18.

Sharoni S, Rahman H, Minhat H, Shariff-Ghazali S, Azman Ong M . The effects of self-efficacy enhancing program on foot self-care behaviour of older adults with diabetes: A randomised controlled trial in elderly care facility, Peninsular Malaysia. PLoS One. 2018; 13(3):e0192417. PMC: 5849313. DOI: 10.1371/journal.pone.0192417. View

19.

Coffey L, Mahon C, Gallagher P . Perceptions and experiences of diabetic foot ulceration and foot care in people with diabetes: A qualitative meta-synthesis. Int Wound J. 2018; 16(1):183-210. PMC: 7949356. DOI: 10.1111/iwj.13010. View

20.

Armstrong D, Boulton A, Bus S . Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017; 376(24):2367-2375. DOI: 10.1056/NEJMra1615439. View