Study On The Causality Between E-health Literacy And Foot Self-care Behaviors Among Patients With High Risk Of Diabetic Foot

Objective1.To investigate the current status and related factors of electronic health literacy among patients with high risk of diabetic foot.2.To analyze the current condition of foot self-care behaviors among patients with high risk of diabetic foot and its’ related factors.3.To explore the correlation between electronic health literacy and foot self-care behaviors in patients with high risk of diabetic patients.MethodsIn this study,a cross-sectional survey design was used.From March 2018 to December 2018,diabetic patients were selected from 10 communities in Hongqiao District,Dongli District,Heping District and Beichen District of Tianjin as the preliminary study subjects,and then the diabetic foot risk screening was conducted.High risk patients were selected as the final study subjects.Collecting general information and related clinical data,electronic health literacy data and foot self-care behaviors data in patient with medium-high risk of diabetic foot.1.The general information was collected using a self-made questionnaires,which included the patient’s age,gender,education,occupation,martial status,medical insurance,drinking and smoking history,diabetes course,etc.2.Relevant clinical dated was based on Gavin’s diabetic foot risk factors weighted value scale,to conduct screening and classification of diabetic foot risk.3.Using the Chinese version of the Electronic Health Literacy scale to conduct a survey on the status of electronic health literacy in selected subjects.4.The Chinese version of Nottingham Diabetes foot Nursing Assessment scale was applied to investigate the condition of foot self-care behaviors in patients with high risk of diabetic foot.Using frequency and composition ratio to describe general data;use mean ±standard deviation to describe the status of electronic health literacy and foot self-care behaviors.Two independent sample t test and variance analysis were used to compare different characteristic differences in electronic health literacy and foot self-care behaviors among patients with high risk of diabetic foot.Pearson’s correlation factoranalysis was used to study the correlation between electronic health literacy and foot self-care behaviors.On the basis of univariate analysis,stratified regression was used to analyze the effect of electronic health literacy on diabetic foot self-care behaviors.ResultsA total of 353 patients with high risk of diabetic foot were investigated in this study,including 235 patients with medium risk and 117 with high risk of diabetic foot.1.Current status of electronic health literacy in patients with high risk of diabetic footThe results of the study showed that the total score of electronic health literacy in patients with high risk of diabetic foot was(21.22±8.545)points.The scores in each dimension were as following: internet information application ability(14.44±6.085)points,network health information decision making ability(3.06 ± 1.268)points and network health information judgement ability(3.72 ± 1.836)points.Among them,the lowest score was the item average score of network health information judgement ability with only(1.85±0.918)points.2.Relevant factors of electronic health literacy in patients with high risk of diabetic footResearch results showed that age,education level,years of illness and risk classification of diabetic foot were related factors of electronic health literacy.Among them,the age between 30～44 years old had higher electronic health literacy than those aged 60 and older(P<0.05);the patients with 5-10 years courses of diabetes had higher scores than those with diabetes course less than 5 years(P<0.05);and the electronic health literacy scores among patients with medium risk of diabetic foot was higher than those with high risk(P<0.05).3.Current condition of foot self-care behaviors in patients with high risk of diabetic footTotal scores of foot self-care behaviors in patients with high risk of diabetic foot was(68.31±11.803)points,of which,19.9% had good foot self-care behaviors,the standard score was more than 80 points;62.5% had a moderate level,the standard score was between 60 to 80 points and another 17.6% had a poor foot self-carebehaviors with the standard score less than 60 points.Among the various dimensions of foot self-care behaviors,the score of the foot daily examination was lower at(34.72±21.09)points.The scores of other dimensions were ranked from low to high as: foot clean dimension of(55.21±22.10),footwear selection dimension of(69.21±12.085),foot protection dimension of(77.81 ± 14.15)and medical behaviors dimension of(84.03±20.18).4.The effect of electronic health literacy on foot self-care behaviors in patients with high risk of diabetic footPearson correlation analysis showed that the electronic health literacy was positively correlated with foot self-care behaviors(r=0.571,P<0.05).The results of stratified regression analysis showed that the electronic health literacy was an important factor influencing foot self-care behaviors(β=1.417,P<0.001),that could independently affect the overall level of foot self-care behaviors.The variation of5.2%,that was,the higher the level of electronic health literacy,the stronger the ability of foot self-care behaviors.Conclusion1.At present,the electronic health literacy of high-risk diabetic foot patients was at a general level.Age,education level,course of disease and diabetic foot risk classification were the relevant factors of electronic health literacy.Therefore,when using or providing electronic and network resources for health education,patients with different characteristics should be given corresponding learning resources and access channels.2.The foot self-care behaviors in high risk of diabetic foot was at the medium level,and the daily examination of foot was the part that most patients didn’t pay attention to,and had a weak compliance.Gender,age,education level and years of illness were the influencing factors of foot self-care behaviors.Therefore,in the propaganda and education of diabetic foot self-care behaviors,the educational focus and form of patients with different characteristic should be considered.Emphasize the importance of foot examination to diabetic patients,and formulate reasonable interventions to strengthen their attention and compliance.3.The result showed that the electronic health literacy of patients with high risk ofdiabetic foot was an important factor in their foot self-care behaviors,and the improvement of the electronic health literacy level had a positive effect on the foot self-care behaviors.Therefore,we should actively conduct research on nursing interventions to improve patients’ electronic health literacy level,strengthening their foot self-care behaviors by improving electronic health literacy.