Purpose: The purpose of this study was to determine the effectiveness of a patient-centered diabetes foot education intervention in a rural clinic, designed to improve patients’ knowledge, as evidenced by an increase in the Patient Interpretation of Neuropathy (PIN) scores from pre-intervention to post-intervention.
Methods: The participants were clinically diagnosed with type 2 diabetes for at least six months and were less than 70 years of age. Patients were excluded if they were more than 70 years of age, had active foot ulcers, with previous minor or major amputations, or Charcot's joints. The Patient Interpretation of Neuropathy (PIN) questionnaire was used. It is a 73-item reliable and valid measurement tool that determined type 2 diabetic patients’ level of understanding of the link between foot ulceration and self-care deficit and evaluated their cognitive and emotional understanding of peripheral neuropathy. A single group pretest-posttest quasi-experimental design was used with a paired samples t-test which compared mean scores for the same group of participants in two different occasions. A priori, G*Power was used to determine the appropriate number of participants needed to detect a difference between pre and post PIN total scores for this study. Estimated sample size needed for power was N=34. A total of 25 participants completed the education intervention with (n=25) pre-test and (n=25) post-test.
Results: There was a significant increase on T2DM patient’s knowledge scores from Pre-educational intervention (M = 261.64, SD = 30.0) to Post educational intervention (M = 327.96, SD = 22.0), t value = 7.952, p = .000 (two-tailed). The Mean difference of the two scores was -66.32, with a 95 percent confidence interval stretching from a lower bound of -83.53334 to an upper bound of -49.10666. The eta squared statistic (.7) indicated an extremely large effect size. The hypothesis and question posed in this study were both answered YES! The use of the HPM theoretical framework and the selected educational material demonstrated significant changes in knowledge and behavior as evidenced by the statistically significant improvement in diabetic patients’ PIN scores from pre to post implementation of diabetic foot care education intervention. The use of this approach and the chosen educational material demonstrated significant changes in knowledge and behavior in this study. Majority of the participants were women which may have increased the probability of female to male ratio.
Conclusion: Diabetic foot education and prevention among diabetic patients in this rural clinic is essential because the knowledge and skills they have acquired as a result of the education intervention have a significant impact in therapeutic outcomes. The findings in post education indicated increased knowledge, willingness and motivation, which are important elements that contribute to behavior change in this patient population.