Study On Knowledge,Attitude And Behavior Scale Of Foot Care In Diabetes Mellitus Population

Object1.To develop "Knowledge,attitude and behavior scale of foot care in diabetes mellitus population" which will be suitable for Chinese diabetes mellitus patients.2.To evaluate the validity,reliability,sensitivity and acceptability of the scale.Subject and MethodsBased on the theory of "Knowledge-Attitude-Behavior",using the internationally recognized scale development procedures and combining the qualitative and quantitative research methods to build the scale.Literature analysis and study group discussion were used to establish the item pool.And the study was based on the study group's experience of developing scales to establish the Delphi expert consultation form.Then two rounds Delphi counseling were carried out to identify the important items and develop a primary scale.Use the pilot study to evaluate and modify the primary scale's surface validity and content validity.After field survey among diabetes patients,data was collected to evaluate the validity,reliability,sensitivity and acceptability of the scale.1.Build the item poolGuided by theory of "Knowledge-Attitude-Behavior",literature review on diabetic foot care(including periodicals,dissertations,books,essays,etc.),which has been published publicly from January 1,2000 to January 1,2017,combined wih the recommendations on diabetic foot care proposed by the foreign and domestic authoritative organizations and study group discussion to build the item pool,Then the study group follows the principles of objectivity,scientificity,importance and applicability to select the core items.After several discussions,the Delphi expert consultation form was developed.2.The Delphi counselingAccording to the purpose of the study,authority experts who specialized in the clinical medicine or nursing of diabetic foot prevention and control were selected in strict accordance with the criteria for the selection of experts.The Delphi expert consultation form was send to experts through E-mail.All the experts were asked to grade the evaluation items and explain the basis of grading judgement and the extent of familiarity.Two rounds expert consultations were conducted.When the level of the active coefficient and authoritative coefficient were met,based on the feedback from experts,items were selected according to the cut-off method.Eventually,a primary scale was formed.3.The pilot studyA convenient sampling method was used to conduct a face-to-face questionnaire survey of 28 diabetes patients in Urban and Ouqu Community Health Service Center in Changshu City.After survey,the initial scale was revised mainly on the expressions of the items.4.The field survey501 diabetes patients from Dayi and Ouqu Community Health Service Center,were investigated through face-to-face investigation.The data was used to evaluate the validity,reliability,sensitivity and acceptability of the scale.The validity evaluation indexes included the surface validity,content validity and construct validity.The reliability evaluation indexes included the internal consistency reliability and split-half reliability.The sensitivity of the scale was assessed by the score differences between high score and low score group.The acceptability of the scale was assessed by the effective response rate and the mean response time.Results1.Build the item poolThe item pool contained the basic knowledge of diabetic foot disease,washing foot(washing foot with warm water,drying foot and toes,foot examination,application of lotion,foot massage,trim toenail),footwear selection,barefoot,keeping foot warm,regular hospital foot examination and medical treatment of foot problems,which included in knowledge,attitude and behavior three dimensions.The knowledge,attitude,and behavior dimensions contained 47,26,and 33 items,respectively,with a total of 106 items.Several rounds of discussion by the study group formed an expert consultation form containing 39 items.2.The Delphi counseling24 experts were invited.The withdraw rate of two rounds Delphi consultation was 91.7%and 100%.The age distribution of experts was balanced,with an average working experience of 21.65±6.04 years.The authoritative coefficient of experts was 0.83 and 0.84.The expert coordination coefficient was 0.199 and 0.197.After two rounds Delphi consultation,the knowledge dimension included 7 items of basic knowledge,washing foot,footwear selection,and medical treatment of foot problems.The attitude dimension included 5 items for the degree of recognition of the regular hospital foot examination,the daily self-examination of the feet,washing foot,keeping foot warm but not close to the heat,and avoiding barefoot.The behavior dimension included 15 items of washing foot,self-examination,application of lotion,trim toenail,barefoot,keeping foot warm,shoes selection,and medical treatment.3.The pilot studyThe primary scale was used by the pilot study.And the expressions of some items were readjusted.4.The field surveyThe data of field survey showed that the scale had good validity,reliability,sensitivity and acceptability.The Spearman correlation coefficient of knowledge,attitude and behavior dimensions with total scale were 0.729,0.713and 0.661,respectively.The average Spearman correlation coefficient of knowledge,attitude and behavior dimensions with their items were 0.690,0.755 and 0.233,respectively.After exploratory factor analysis,a total of 9 common factors were extracted.The common factor cumulative variance contribution rate of these nine common factors was 60.406%.And the communality of the items that included in the factor analysis was between 0.428 and 0.729.The Cronbach a coefficient,y coefficient,and ?coefficient that reflected the internal consistency reliability of the total scale were above 0.750.The split-half reliability of the total scale was 0.877.The scores of the total scale,the knowledge,the attitude,and behavior of the subjects in the high and low group were statistically different,P<0.001.The effective response rate of the scale was 100%,and the average response time was between eight to thirteen minutes.ConclusionsThe diabetes foot care knowledge,attitude and behavior evaluation scale has good validity,reliability,sensitivity and acceptability among diabetes patients.The scale can be used in surveys focused on knowledge,attitude and behavior condition of diabetes population.