A Descriptive study to assess the Knowledge and Practices regarding Foot Care of Clients who are suffering from Diabetes in a selected community area of Haldwani block.

 

Ms Rekha Kumari1, Ms Himani Chauhan2

1Assistant Professor, Obstetrical and Gynaecological Nursing, Sharda University, Grater Noida, U.P

2Nursing Tutor, Pal College of Nursing, Haldwani, Uttrakhand

*Corresponding Author E-mail: rekhadobal@gmail.com

 

ABSTRACT:

Objectives:

1) To assess the knowledge regarding diabetic foot care of clients suffering from diabetes.

2) To assess the practices regarding diabetic foot care of clients suffering from diabetes.

3) To find the association between knowledge and practices regarding diabetic foot care with selected socio- demographic variables.Method and Material: A total of 60 diabetic clients living in Haldwani block were included in the study. A purposive sampling technique was used for the study. Data was collected by using self structured knowledge questionnaire and observational practice check list. Major findings: Out of 60 samples (21.67%) fall under the age group of 60-65 years. Majority of the sample consisted of females (61.6%). Regarding their educational background most of them (40%) had qualification of primary education. Among the subjects (53.3%) were unskilled and (46.6%) were skilled. One- third (31.6%) of the clients were having income between of Rs.5, 000-10,000. 55 clients lived in joint family. Fifty six percent of the subjects were non-vegetarians. Regarding the habits, 56.6% were not having any of the habits such as smoking, alcoholism, and tobacco chewing. 55% of the clients had been suffering from diabetes from <5years. Hypertension and diabetes was prevalent among 56% of the clients. The knowledge and practice score was computed which showed that the average Knowledge score was (2.9±1.50) and average Practice score was (4.25±1.65). The study also revealed that there was a significant association of Age (t=2.71, df =58 and p<0.05), Habits (t=2.37, df =58 and p<0.05) with the knowledge of diabetic foot care. There was a significant association of Educational status (t=2.57, df=58 and p<0.05), Dietary Pattern (t=4.10, df=58 and p<0.05)) and Habits (t=2.73, df=58 and p<0.05) with practice of diabetic foot care. Conclusion: On the basis of our study finding it can be concluded that the knowledge was having significant association with age and habits. In practice educational status, dietary pattern and habits having significant association. So more should be done to educate the diabetic clients regarding the appropriate knowledge of diabetes and foot care practices from the initial time of the disease and enhance their knowledge by providing them “Informational Booklet”.

 

KEYWORDS: Knowledge, Practices, Foot Care and Diabetes.

 


 

INTRODUCTION:

India is known as the “Diabetes capital” of the world with more than 40 million people with diabetes.1Diabetes mellitus is a multifaceted disease and foot ulceration is one of its most common complications. Poor foot care and knowledge and practices are important risk factors for foot problems among people with diabetes. The incidence of foot ulcers among people with diabetes ranges from 8% to 17%.2Poor knowledge of foot care and poor foot care practices were identifies as important risk factor for foot problems in diabetes. People with diabetes have a number of potentially serious health problems that can be cause by condition, including eye, heart, feet and kidney disease. One of the most common is diabetes related foot problems.3

 

According to the international diabetic federation (IDF) in an effort to reduce the number of amputations among people with diabetes.4Lower limb complications in diabetes are a frequent and seriously disabling condition, affecting both quality of life and health care utilization (bild et al., 1989; humphery, dowse, thoma and zimmet.1996). Diabetes is the leading cause of lower limb amputation, generally preceded by foot ulcers and gangrene. Foot ulceration may be occur up to 15% of diabetic patients during their lifetime and about 14-24% of people with a foot ulcer will require an amputation (senders 1994).5

 

People with diabetes are at risk of nerve damage (neuropathy) and problems with blood supply to their feet (ischemia).complication affecting the lower limb are among the most common manifestations of diabetes .Both neuropathy and ischemia can lead to foot ulcers and slow healing wounds which, if they get infected, may result in amputation.6 Extensive epidemiology surveys have indicated between 40% -70% of all lower extremity amputations are related to diabetes .This means that Every 30 seconds a lower limb is lost due  to diabetes .For most people who have lost a leg, life will never return to normal. Amputation may involves lifelong dependence upon the help of others, inability to work and much misery. Ulcer reoccurrence rate is higher, but appropriate education for patient, the provision of post healing footwear and regular foot care can reduce rate of re –ulceration.7

 

More than half (55%) of these death occur in people under the age of 60 years and almost a third (27%) under the age of 50.Diabetes education and prevention is the world diabetes day (November 14) theme for the period 2009-2013.8

Diabetes is the third leading cause of death by disease. People with diabetes are prone to foot problems because of the disease can cause damage to the blood vessels and nerves. Myths and misconception among diabetes related to foot care contribute to high prevalence of the peripheral neuropathy complications, which once developed then the treatment is not only lifelong but also financially exhausting. The centers for disease control and prevention has determined that 'Regular foot care can reduce serious foot disease by 50 to60%affecting the quality of life of our aging population''. 9

 

METHODOLOGY:

The study was conducted in a community area haldwani block. Quantitative survey approach was used. Non experimental (descriptive) study was the research. 60 diabetic foot care of clients suffering from diabetes was taken as the samples selected by with purposive sampling with non-probability sampling technique.

 

Data Analysis:

Socio-demographic characteristics were described using frequency and percentage. Independent t-test to be performed to determine the association between knowledge and practices regarding foot care of clients who are suffering from diabetes with the socio-demographic variables.

 

RESULTS:

Section I:-Description of Sample Characteristics:

The samples was collected for the study consisted of 60 clients suffering from diabetes from golapaar (khera) kathgodam, haldwani. This section deals with the description of sample characteristics of the client who has suffering from diabetes and is explained in frequency and percentage and is presented in the table form and bar diagram of age group.

 

Fig 1: Frequency and Percentage Distribution Of Age Group:-

 

Fig. 1 shows that majority of the diabetes client 21.67% fall under the age group of 60-65years, 18.33% of them fall under the age group of 55-60 years, whereas only 3.33% of them fall under the age group of 40-50 years.


 

Table 1

S.NO.

VARIABLES

CATEGORIES

FREQUENCY (60)

PERCENTAGE-100

1

Gender

Male

23

38.3

Female

37

61.6

2

Educational Status

No formal education

20

33.3

Primary education

24

40

Middle education

12

20

Higher education

4

6.6

3

Occupation

Skilled

28

46.6

Unskilled

32

53.3

4

Income

<5000 or less

18

30

5000-10000

19

31.6

10000-15000

15

25

>15000

8

13.3

5

Type Of Family

Nuclear

27

45

Joint

33

55

6

Dietary Pattern

Vegetarian

26

43.3

Non-Vegetarian

34

56.6

7

Habits

Smoking

14

23.3

Alcohol

12

20

Chewing Tobacco

0

0

Nil

34

56.6

8

Duration Of Illness

<5 yrs

33

55

5-10 yrs

16

26.6

10-15 yrs

4

6.6

>15 yrs

7

11.6

9

Associated Illness

Hypertension

34

56.6

Cataract

5

8.3

No other disease

21

35

 


Inference:

Majority females 61.6% participated in our study. Mostly 40% of the client were reported to have an primary education, 33.3% were having no formal education in a community area. Majority 53.3% of the clients were unskilled, 46.6% were skilled. Majority 31.6% of client were having income of Rs.5,000-10,000 and more 13.3% belong to >Rs.15,000. Mainly 55% client lived in joint family,45% belong to nuclear family. Majority 56.6% client were having non-vegetarian dietary pattern, 43.3% were having vegetarian dietary pattern. Most 56.6% clients were having no any habits. Mostly 55% client were having duration of illness from <5years.  Majority 56.6% of client were having hypertension along with diabetes. 

 

SECTION II – Knowledge level of diabetic client regarding diabetic foot care:

Knowledge level of 60 diabetic client was assessed using structured knowledge questionnaire and was analyze using descriptive and inferential statistics. The range, mean. Median and standard deviation have been calculated. The maximum possible score for the knowledge questionnaire was 10, out of which the knowledge scores was graded as “adequate and inadequate” using the formula “mean ± standard deviation”, the samples that have scored <5 are treated as “inadequate knowledge (0-5)” and the samples that have been scored between (6-10) are treated as “adequate knowledge”. Thus the knowledge diabetic client regarding diabetic foot care are represented in the following table.

 

Table 2: Range, Standard Deviation and Median of knowledge score regarding diabetic foot care of client suffering from diabetes.N=60

Variable

Range

Mean±sd

Median

Knowledge Score

1-10

2.9±1.50

1.5

Maximum possible score = 10

 

Table 3: Frequency and Percentage Distribution Of Diabetic Clients According To Grading Of Knowledge Score N=60

Knowledge score

Frequency (f)

Percentage (%)

Adequate Knowledge (6-10)

2

3.3%

Inadequate Knowledge (0-5)

58

96.7%

Maximum possible score = 10

 

 

Fig 2:    Association of knowledge questions related to diabetic foot

SECTION III Practice level of diabetic clients regarding diabetic foot care:

Practice level of 60 diabetic clients was assessed using structured practice questionnaire and was analyze using descriptive and inferential statistics. The Range, Mean. Median and Standard deviation have been calculated. The maximum possible score for the practice questionnaire was 10, out of which the practice scores was graded as “adequate and inadequate” using the formula “mean ± standard deviation”, the samples that have scored <5 are treated as “inadequate practice (0-5)” and the samples that have been scored between (6-10) are treated as “adequate practice”. Thus the practice diabetic client regarding diabetic foot care are represented in the following table.

 

Table 4: Range, Mean and standard deviation of practice score regarding diabetic foot care of client suffering from diabetes. N=60

VARIABLE

RANGE

MEAN±SD

Practice Score

1-10

4.25±1.65

Maximum possible score = 10

 

Table 5: Frequency and Percentage Distribution of Diabetic Clients According To Grading Of Practice Scores          N=60

PRACTICE SCORE

FREQUENCY (F)

PERCENTAGE (%)

Adequate  practice  (6-10)

14

23.3%

Inadequate Practice (0-5)

46

76.7%

Maximum  possible score = 10

 

Fig 3:    Association of Practice questions related to diabetic foot

 

SECTION IV – Association between Knowledge level and selected socio demographic variables. To test the association, independent (t-test) was applied and the results were presented in a tabular form.

 

 

 

 

 


 

Table 6: Association of knowledge regarding diabetic foot care with selected socio- demographic variables -:       N=60

S.No.

Variables

Categories

F

Mean± SD

Mean difference

T value

P value

1

Age (in years)

40-60

30

2.86±1.63

1.14

2.71

 

61-80

30

4.0±1.63

<0.05

2

Gender

Male

23

3.08±1.74

0.3

0.68

>0.05

Female

37

2.78±1.59

3

Educational Status

No formal education and

44

2.86 ±1.50

0.26

0.57

>0.05

Primary education

 

 

Middle education and

 

3.12±1.57

Higher education

16

 

4

Occupation

Skilled

28

3.0±1.69

0.13

0.33

>0.05

Unskilled

32

2.87±1.36

5

Income

below5000 -10000

38

2.89±1.58

0.11

0.28

>0.05

10001-15000above

22

3.0±1.41

6

Type Of Family

Nuclear

26

3.23±1.47

0.53

1.39

>0.05

Joint

33

2.70±1.52

7

Dietary Pattern

Vegetarian

25

2.92±1.46

0.04

0.1

>0.05

Non-Vegetarian

35

2.88±1.52

8

Habits

Smoking and Alcohol

21

2.28±1.54

0.95

2.37

<0.05

Nil

 39

3.23±1.36

9

Duration Of Illness

below5 yrs-10yrs

49

2.95±1.62

0.32

1.1

 

11-16yrsabove

11

2.63±0.64

>0.05

10

Associated Illness

Hypertension and Cataract

39

2.82±1.46

0.27

0.64

>0.05

No other disease

21

3.09±1.60

 


Inferences:

To test the association between knowledge score that there is significant association of  Age(t=2.71, df=58 and p<0.05) and Habits(t=2.37, df=58  and p<0.05)regarding diabetic foot care  and no other significant association of the selected variables like- gender, educational status, occupation, income, dietary pattern, type of family, duration of illness  and associated illness.

 

SECTION V – Association between Practice level and selected socio demographic variables.

To test the association, independent (t-test) was applied and the results were presented in a tabular form.


 

Table 7:Associationbetween practices regarding diabetic foot care with selected socio- demographic variables

S.NO.

Variables

Categories

F

Mean± sd

Mean difference

T value

P value

1

Age (in years)

40-60

30

3.96±1.55

0.57

1.39

>0.05

61-80

30

4.53±1.70

2

Gender

Male

23

4.43±1.63

0.29

0.71

>0.05

Female

37

4.13±1.66

3

Educational Status

No formal education and Primary education

44

3.97±1.74

1.03

2.57

<0.05

Middle education and

 

5.0±1.32

Higher education

16

 

4

Occupation

Skilled

28

4.14±1.80

0.14

0.2

>0.05

Unskilled

32

4.28±1.56

5

Income

below5000 -10000

38

4.28±1.63

0.1

0.22

>0.05

10001-15000above

22

4.18±1.79

6

Type Of Family

Nuclear

26

4.69±1.61

0.78

1.85

>0.05

Joint

33

3.91±1.76

7

Dietary Pattern

Vegetarian

25

5.16±1.63

1.56

4.1

<0.05

Non-Vegetarian

35

3.6±1.38

8

Habits

Smoking and Alcohol

21

3.57±1.32

1.04

2.73

<0.05

Nil

39

4.61±1.70

 

9

Duration Of Illness

below5 yrs-10yrs

49

4.26±1.72

0.36

0.97

>0.05

11-16yrsabove

11

3.90±0.99

10

Associated Illness

Hypertension and Cataract

39

4.05±1.75

0.56

1.4

>0.05

No other disease

21

4.61±1.38

 


Inferences:

To test the association between knowledge score that there was significant association of Educational status(t=2.57, df=58  and p<0.05),Dietary pattern(t=4.10, df=58  and p<0.05)) and Habits (t=2.73, df=58  and p<0.05)regarding diabetic foot care  and no other significant association of the selected variables like- age, gender, , occupation, income, type of family, duration of illness  and associated illness.

 

MAJOR FINDINGS:

Out of 60 samples (21.67%) fall under the age group of 60-65 years. Majority of the sample consisted of females (61.6%). Regarding their educational background most of them (40%) had qualification of primary education. Among the subjects (53.3%) were unskilled and (46.6%) were skilled. One- third (31.6%) of the clients were having income between of Rs.5, 000-10,000. 55 clients lived in joint family. Fifty six percent of the subjects were non-vegetarians. Regarding the habits, 56.6% were not having any of the habits such as smoking, alcoholism, and tobacco chewing. 55% of the clients had been suffering from diabetes from <5years. Hypertension and diabetes was prevalent among 56% of the clients.

 

The knowledge and practice score was computed which showed that the average Knowledge score was (2.9±1.50) and average Practice score was (4.25±1.65). The study also revealed that there was a significant association of Age (t=2.71, df =58 and p<0.05), Habits (t=2.37, df =58 and p<0.05) with the knowledge of diabetic foot care. There was a significant association of Educational status (t=2.57, df=58 and p<0.05), Dietary Pattern (t=4.10, df=58 and p<0.05)) and Habits (t=2.73, df=58 and p<0.05) with practice of diabetic foot care.

CONCLUSION:

On the basis of our study finding it can be concluded that the knowledge was having significant association with age and habits. In practice educational status, dietary pattern and habits having significant association. So more should be done to educate the diabetic clients regarding the appropriate knowledge of diabetes and foot care practices from the initial time of the disease and enhance their knowledge by providing them “Informational Booklet”.

 

REFERENCES:

1.       Diabetes fact sheet N0312. Geneva, Switzerland: world health organization; 2009. World health organization.

2.       Crawford, F Inkster M, Kleijnen J, faheyT. Predicting foot ulcer in patients with diabetes:a systematic review and mata analysis .Q J Med.2007;100:65 -86.

3.       Chandalia HB, Singh D, Kapoor V, Chandalia SH, Lamba PS. footware and foot care knowledge as risk factors for foot problems in indiadiabetes. Int J diabetes Dev Ctries.2008; 28:109 13.

4.       Altaflal A. Defeat diabetes: 70% leg amputation duetodiabetes. USpost 2005May2: Section A: 11 of 2.

5.       Sanders lj : diabetes milletus .prevention of amputation. Journals of the American podiatric medical association 84 322-328, 1994.)

6.       Type 1 diabetes statistics. Available from :http://www.organisedwisdom.com.

7.       Health topic: WHOdiabetes. avaiable from: http://www.who.int/diabetes/en/index.html.

8.       International diabetes federation. The diabetic foot: amputation are preventable, amy 2005 avialable from: http://www.ifd.org/position.statement-diabeticfoot reviewed on 22/12/2011.

9.       IDF diabetes altals: the global burden.5thedition.available from: http://www.idf.org/diabetesatlas/5e/the_global_burdan.

 

 

 

Received on 28.05.2018        Modified on 14.06.2018

Accepted on 12.07.2018       ©A&V Publications All right reserved

Int.  J. of Advances in Nur. Management. 2018; 6(3): 205-209.

DOI: 10.5958/2454-2652.2018.00045.8