Happy Feet in a Rural Clinic: A Diabetic Foot Education Intervention

The prevalence of Type 2 Diabetes is higher in rural areas than in urban areas and this population have more barriers to health care (Rural Healthy People, 2010). Many diabetic patients in disparate population in rural communities do not receive the established diabetes standards of care such as foot screenings and diabetic foot prevention education which contribute to incidence in foot ulcer formation and amputations (Agency for Healthcare Research and Quality, 2008). The complexity of Diabetes requires a multidisciplinary approach which in most cases may not be available in many rural health care settings (Abu Qamar, 2012). Fragmented diabetic patient education leads to non-compliance, diabetic foot ulcer development and subsequent rise in lower limb amputations. Under usage of the diabetes standards of care among disparate population can be addressed by implementation of an evidenced based diabetic foot education intervention. Purpose: The purpose of this study was to determine the effectiveness of a patient-centered diabetes foot education intervention in a rural clinic, designed to improve patients’ knowledge, as evidenced by an increase in the Patient Interpretation of Neuropathy (PIN) scores from pre-intervention to post-intervention. Methods: The participants were clinically diagnosed with type 2 diabetes for at least six months and were less than 70 years of age. Patients were excluded if they were more than 70 years of age, had active foot ulcers, with previous minor or major amputations, or Charcot's joints. The Patient Interpretation of Neuropathy (PIN) questionnaire was used. It is a 73item reliable and valid measurement tool that evaluated type 2 diabetic patients’ level of understanding of the link between foot ulceration, self-care deficit, cognitive and emotional understanding of peripheral neuropathy. A single group pretestposttest quasi-experimental design was used with paired samples t-test which compared mean scores for the same group of participants in two different occasions. To estimate the sample size, a priori, G*Power was used to determine the appropriate number of participants needed to detect a difference between pre and posttest PIN total scores with 95% confidence that the difference was real. Estimated sample size needed for power was N=34. A total of 25 participants completed the education intervention with (n=25) pre-test and (n=25) post-test. Results: There was a significant increase on T2DM patient’s knowledge scores from Pre-educational intervention (M = 261.64, SD = 30.0) to Post educational intervention (M = 327.96, SD = 22.0), t value = 7.952, p = .000 (two-tailed). The Mean difference of the two scores was -66.32, with a 95 percent confidence interval stretching from a lower bound of -83.53334 to an upper bound of -49.10666. The eta squared statistic (.7) indicated an extremely large effect size. Majority of the participants were women which may have increased the probability of female to male ratio. The hypothesis and question posed in this study were both answered YES. The use of the HPM theoretical framework and the selected educational material demonstrated significant changes in knowledge and behavior as evidenced by the statistically significant improvement in diabetic patients’ PIN scores from pre to post implementation of diabetic foot care education intervention. Conclusion: The use of a scientific approach, such as evidence-based practice, plays a crucial role in the provision of appropriate care to patients. The move towards evidenced based practice paves the way for healthcare professionals to move away from long-established style of care delivery to the new paradigm where decisions are driven according to the best evidence available. The hypothesis and question posed in this study were both answered yes. The use of Pender’s health promotion model as theoretical framework and the selected standardized educational materials demonstrated significant changes in the knowledge and behavior of the participants in this study as evidenced by improvement in diabetic patients’ PIN scores from pre to post implementation of a diabetic foot care prevention education. The findings indicated increased knowledge, willingness and motivation, which are important elements that contribute to behavior change in this patient population. Diabetic foot education and prevention among diabetic patients in this rural clinic is essential because the knowledge and skills acquired as a result of the education intervention will have a significant impact in therapeutic outcomes among this patient population.