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

Hyemin Kim; Ji Min Seo

doi:10.12799/jkachn.2019.30.4.560

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Kim and Seo: Effects of Diabetic Foot Care Education for the Aged with Low Health Literacy

Original Article

J Korean Acad Community Health Nurs 2019;30(4):560-570.

Published online: 12 December 2019

DOI: https://doi.org/10.12799/jkachn.2019.30.4.560

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

Hyemin Kim¹, Ji Min Seo²

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 10 July 2019 Revised 11 November 2019 Accepted 17 November 2019

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.

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

References

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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
Characteristics		Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
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
Variables	Groups	M±SD	M±SD	M±SD	t	p
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
Characteristics	Categories	n (%)	n (%)	x²	p
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.

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