| Objective:This research is focused on the problems of the insufficient foot care cognition,poor foot care behavior,and standardized foot ulcer risk grading education program in the practice of foot care education for elderly type 2diabetes high-risk foot patients.According to the evidence-based method,under the guidance of Integrated Theory of Health Behavior Change(ITHBC),through the quality evaluation,sorting and extraction of literature,combined with group discussion and Delphi method,a foot care health education program for elderly patients with high-risk foot of type 2 diabetes mellitus was constructed.It was verified to help patients adopt and maintain foot care behavior,prevent the occurrence of Diabetic foot ulcer and improve health status.Methods:Firstly,this study constructed health education programs on foot care for elderly high-risk foot patients with type 2 diabetes.According to the 6S evidence model,domestic and foreign literatures related to diabetes high risk foot health education were systematically searched from top to bottom.The quality evaluation criteria of the included guidelines,expert consensus and other literatures were respectively adopted to AGREEⅡ,JBI and Cochrane systematic evaluation manual for quality evaluation.Meanwhile,the content of the literature was analyzed and summarized.With the integrated theory of health behavior change as the research framework,the core elements were extracted to form the framework of foot care and health education program for elderly high-risk foot patients with type 2 diabetes.Secondly,the draft of foot care and health education program for elderly high-risk foot patients with type 2 diabetes was formed through discussion among group members.The Delphi method was adopted to select 17 experts in related disciplines for two rounds of correspondence consultation,and the first draft of foot care health education program was revised to form the final draft.Secondly,this study verified the feasibility of the foot care health education program for the elderly type 2 diabetes high-risk foot patients.Thirty-five elderly high-risk foot patients with type 2 diabetes who met the sodium standard in the endocrinology department of a third-class A hospital in Nanning were randomly selected as the research objects to carry out foot nursing and health education for 3 months.General data questionnaire,diabetic foot care behavior questionnaire,diabetic foot knowledge questionnaire,diabetic foot self-efficacy scale,diabetic survival specificity scale,and IWGDF risk grading system were used to investigate the feasibility of the foot care health education program.Results:This study included 30 articles through literature search and screening,including 8 guidelines,6 systematic evaluation or meta-analysis,2 expert consensus and 14 randomized controlled studies.Of the eight guidelines included,2 were rated as Grade B and 6 were rated as Grade A.The quality evaluation results of the remaining documents are high,and they are all included.Based on theoretical analysis,two levels of the scheme,namely module and theme were extracted.The four core elements of the module include foot health knowledge education,belief education,self-regulation ability training and social promotion.The 14 core elements of the theme part include the clinical manifestation and risk factor identification of diabetes foot,IWGDF risk classification and regular inspection of high-risk foot,foot cleaning and protection,foot exercise program,traditional Chinese medicine foot bath,etc.At the same time,the goal,time and form of foot care health education were established.After group discussion,the first draft of the foot care health education program including 4 modules,14 topics and 40 operation items were formed.Then,17 experts in relevant fields were invited to conduct correspondence.The effective recovery rates of the two rounds of expert correspondence questionnaires were 94% and 88% respectively,the authority coefficients of experts were 0.863 and 0.867,and the Kendall harmony coefficient was 0.135-0.209(P<0.05).The final foot care health education program includes 4 modules,14 themes and 43 operation items,including education objectives,objects,implementers,places,time,forms,and foot health knowledge education,confirmation of health beliefs,cultivation or enhancement of self-regulation ability and social promotion.Secondly,35 elderly patients with high risk foot of type 2 diabetes were selected for a 3-month observation.The results showed that the scheme was feasible and compared with before intervention,after intervention,the score of foot nursing behavior of patients increased from(56.09±9.48)points to(60.43±7.39)points,and the score of foot nursing knowledge increased from[25.71(20.00,34.29)] points to [68.57(60.00,74.29)] points.Foot care self-efficacy score increased from(64.97±11.71)points to(67.15±10.04)points,quality of life score decreased from(54.33±7.64)points to(51.18±6.71)points,the differences were statistically significant(P<0.05).No adverse events such as diabetic foot ulcer occurred during the implementation of the program.Conclusion:The foot care and health education program for elderly patients with high-risk foot of type 2 diabetes in this study was based on evidence-based,ITHBC framework,group discussion and Delphi method.The research method is appropriate,the research process is reasonable,and the results of literature analysis and Delphi method are reliable.The validation results show that the scheme is feasible and the patients’ foot care behavior and quality of life have been significantly improved.Therefore,the constructed foot care health education scheme has promoted the formation of a healthy lifestyle for the elderly patients with type 2 diabetes high-risk foot,guaranteed the health of patients,and can be further promoted in clinical application. |
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