The Comparative Study Of Three Health Education Methods On Foot Care Of Type 2 Diabetes Patients With High Risk Factors Of Diabetic Foot

Diabetic foot is a common chronic diabetic complication with expensive treatment, high recurrence and mortality rate. It has become a worldwide public health problem. Many studies focused on treatments on diabetes in past years, but relative few nursing intervention studies for high risk patients. Diabetes health education mainly contains conversation map-based education, group education, one to one education in China. Plenty of studies have confirmed that above mentioned education have relatively significant effect in clinics, but there are relative short of studies on comparative analysis and long-term effect among three health education methods. Meanwhile there is no uniform tool to assess foot-care behavior in diabetes.Objective: Aim to translate and formulate a foot-care scale with good reliability and validity, which is applicable to patients at high risk of diabetic foot to assess foot-care behavior level in China. Implement three educational methods(conversation map-based education, group education and one to one education) on type 2 diabetes patients at high risk of diabetic foot and follow up 24 weeks to discuss consequence difference among three interventions on blood glucose control, foot-care behavior and general foot condition. Apply t test, one-way ANOVA, Fisher’s exact test, repeated measures ANOVA, Kruskal-Wallis H test, chi-square test and multiple step-wise linear regression to analysis data.Methods: Apply convenience sampling method to select 112 cases of type 2 diabetes patients at high risk of diabetic foot. All study participants are divided into conversation map-based group(group A) 38 cases, group education group(group B) 37 cases and one to one education group(group C) 37 cases. Group A: adopt interactive education with the help of a diabetic foot-care "dialogue" picture launched by the international diabetes federation. Group B: use group education with the help of multimedia slide-show. Group C: employ face to face teaching method which is based on pamphlets for diabetic foot care. Every participant is handed out with one educational pamphlets for diabetic foot prevention and is followed up on telephone at 4, 12 and 24 weeks after intervention to analysis the current blood glucose control, foot-care behavior and general foot condition.Results: 1. CNAFF is clinical valuable with relative good reliability and validity. It can be applied in type 2 diabetes patients at high risk of diabetic foot. 2. The cross-sectional study showed that foot-care behavior level is relatively low in type 2 diabetes patients at high risk of diabetic foot. Gender, previous diabetes foot-care education and previous diabetic foot ulcer history are independent risk factors for foot-care behavior. 3. There is no significant difference among the three groups in FBG, P2 BG and Hb A1 c before and after intervention(P>0.05). 4. All the three health education methods can improve patients’ foot-care behavior level with rise-fall trend, scoring highest at 4th week but higher or equal to baseline level at 24 th week after intervention. One to one education scored highest on foot-care behavior with statistically significant difference(P<0.05), while there is no significant difference between map-based education and group education(P>0.05). 5. There is no significant difference among three groups in general foot condition and foot injury incidence rate after intervention(P>0.05). Five cases of patients suffering from foot injury(4.46%) and no foot amputation occurred.Conclusion: CNAFF could be applied as an measurement for type 2 diabetes patients at high risk of diabetic foot. The general level of foot-care behavior was relatively lower in type 2 diabetes patients at high risk of diabetic foot. The patient, who was female with previous DM foot care education and diabetic foot ulcer history, scored higher on foot-care behavior. All the three education methods could improve foot-care behavior level in type 2 diabetes patients at high risk of diabetic foot, but one to one education had better results than others in short-term and long-term. Therefore, as for type 2 diabetes patients at high risk of diabetic foot, one to one education was suggested to improve foot-care behavior level to reduce the incidence of diabetic foot ulcer and amputation to improve the quality of life.