Original Article

Factors influencing foot care behavior among patients with type 2 diabetes mellitus who have a high-risk diabetic foot in China

Abstract

Background & Aim: Foot ulceration and amputation have increased significantly among Chinese patients with type 2 diabetes mellitus. Proper foot care behavior is an important strategy for reducing the risk of diabetes-related foot issues. The current study aimed to assess foot care behavior and its influencing factors, including self-efficacy, foot care knowledge, and social support, among patients with type 2 diabetes mellitus who have a high-risk diabetic foot in Wenzhou, China.
Methods & Materials: This research used a correlational predictive design. In total, 107 participants who were eligible for the study were randomly selected. Five self-reported questionnaires, including the demographic questionnaire, Diabetes Self-Efficacy Scale, Foot Care Knowledge questionnaire, Perceived Social Support Scale, and Chinese version of the Nottingham Assessment of Functional Footcare, were utilized. Descriptive statistical and standard multiple linear regression analyses were performed to evaluate data.
Results: Approximately 90.7% of participants had poorly controlled diabetes (HbA1c≥ 7%), and 95.3% presented with foot deformities. Further, 51.4% of participants reported moderate foot care behavior, and 42.1% had poor foot care behavior. The multiple regression analysis revealed that self-efficacy, foot care knowledge, and social support significantly explained 31.1 % of the variability in foot care behavior. However, self-efficacy could predict foot care behavior (β= .490, p< .001).
Conclusion: It is important to improve foot care behavior among patients with type 2 diabetes who have a high-risk diabetic foot. Nursing interventions to enhance foot care behavior should focus on improving self-efficacy and providing foot care education regularly.

1. International Diabetes Federation [IDF]. IDF Diabetes Atlas Brussels, Belgium: International Diabetes Federation; 2021 [Available from: https://www.diabetesatlas.org. Accessed May 27, 2022.
2. Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Hinchliffe RJ, Lipsky BA. Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metabolism Research and Reviews. 2020;36(1):e3266
3. Zhang PZ, Lu J, Jing YL, Tang SYY, Zhu DL, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis (dagger). Annals of Medicine. 2017;49(2):106-16.
4. Raghav A, Khan ZA, Labala RK, Ahmad J, Noor S, Mishra BK. Financial burden of diabetic foot ulcers to world: a progressive topic to discuss always. Therapeutic Advances in Endocrinology and Metabolism. 2018;9(1):29-31.
5. Wang C, Ran XW. Where is the way for diabetic foot management in China? Chinese Journal of Diabetes. 2018;10(07):441-4.
6. McInnes A, Jeffcoate W, Vileikyte L, Game F, Lucas K, Higson N, et al. Foot care education in patients with diabetes at low risk of complications: A consensus statement. Diabetic Medicine. 2011;28(2):162-7.
7. Yuan XY, Liu J, Yuan GH, Guo XH. A multi-centered study in diabetic at-risk foot screening and risk factor analysis in Beijing. Chinese Journal of Diabetes. 2020;28(07):486-91.
8. Mogre V, Johnson NA, Tzelepis F, Shaw JE, Paul C. A systematic review of adherence to diabetes self‐care behaviours: Evidence from low‐ and middle‐income countries. Journal of Advanced Nursing. 2019;75(12):3374-89.
9. Sen HTN, Visudtibhan PJ, Siripitayakunkit A. Factors Related to Foot Care Behaviors Among Patients With Type 2 Diabetes Mellitus in Da Nang, Vietnam. Ramathibodi Medical Journal. 2019;42(3):57-68.
10. Sari Y, Upoyo AS, Isworo A, Taufik A, Sumeru A, Anandari D, et al. Foot self-care behavior and its predictors in diabetic patients in Indonesia. BMC Research Notes. 2020;13(1):38.
11. Chen XF, Xu N, Zhang S, Zheng GQ, Li XM. Study on foot self-management behavior and its influencing factors in high-risk diabetic foot patients. Journal of Nurses Training. 2019;34(12).
12. Li J, Xing QL. Study on the reliability and validity of the Chinese version of the Nottingham Assessment of Functional Footcare Chinese Journal of Practical Nursing. 2015;31(06):450-3.
13. Sharoni SA, Razi MM, Rashid NA, Mahmood YE. Self-efficacy of foot care behaviour of elderly patients with diabetes. Malaysian Family Physician: The Official Journal of The Academy of Family Physicians of Malaysia. 2017;12(2):2-8.
14. Indrayana S, Guo SE, Lin CL, Fang SY. Illness Perception as a Predictor of Foot Care Behavior Among People With Type 2 Diabetes Mellitus in Indonesia. Journal of Transcultural Nursing. 2019;30(1):17-25.
15. Peng M, Xu JC, Zhou QH, Fu XA, Zhou LH, Yu L. Context Factors of Foot Self-management Behavior of Patients with Type 2 Diabetes Mellitus on the Basis of IFSMT. Nursing Journal of Chinese People's Liberation Army. 2019;36(02):21-5.
16. Xu HJ, Huang JF, Shen Y, He XL, Xing LL. An Investigation of Foot Care Behavior and Multiple Linear Regression Analysis of Influential Factors in Patients with Type 2 Diabetes Mellitus in Jinshan District of Shanghai. Chinese Journal of Practical Nursing. 2019;35(27):2086-90.
17. Bandura A. Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ, US: Prentice-Hall; 1986.
18. Bandura A. Health promotion by social cognitive means. Health education & behavior : the official publication of the Society for Public Health Education. 2004;31(2):143-64.
19. Tabachnick BG, Fidell LS. Using Multivariate Statistics 7th ed: Pearson Education, Inc.; 2007. P.123.
20. Wang JX, Wang RX, Lin QJ. Self-Care Behaviors and Related Factors in Outpatients Newly Diagnosed with Non-Insulin-Dependent Diabetes Mellitus. The Journal of Nursing. 1998;45(02):60-73
21. Hurley AC, Shea CA. Self-efficacy: strategy for enhancing diabetes self-care. The Diabetes Educator. 1992;18(2):146-50.
22. Li R, Yuan L, Guo XH, Lou QQ, Zhao F, Shen L, Zhang MX, Sun ZL. The current status of foot self-care knowledge, behaviours, and analysis of influencing factors in patients with type 2 diabetes mellitus in China. International Journal of Nursing Sciences. 2014 Sep 1;1(3):266-71.
23. Jiang QJ. Preceived social support scale. In: Editorial Board of Chinese Behavioral Medical Sciences, editor. Manual of Behavioral Medicine Scales. 206-207. China, Beijing: Chinese Medical Multimedia Press; 1996.
24. Blumenthal JA, Burg MM, Barefoot J, Williams RB, Haney T, Zimet G. Social support, Type A behavior, and coronary artery disease. Psychosomatic Medicine. 1987;49(4):331-40.
25. Lincoln NB, Jeffcoate WJ, Ince P, Smith M, Radford KA. Validation of a new measure of protective footcare behaviour: the Nottingham Assessment of Functional Footcare (NAFF). Practical Diabetes International. 2007 May;24(4):207-11.
26. Ding B, Zhang NN, Lu FT, Zeng H. Influence factors of self-care activities and self-efficacy of patients at high risk of diabetic foot Chinese Journal of Modern Nursing. 2016;22(21):3010-14
27. Yang L, Qi YQ, Jiang CN, Wu XD, Zhang LF, Xie W. Stages of Foot Self-care Behavior Among Patients at High-risk of Diabetic Foot: The Influencing Factors. China Academic Journal. 2021;36(19):23-7.
28. Abubakari A-R, Jones MC, Lauder W, Kirk A, Anderson J, Devendra D. Associations between knowledge, illness perceptions, self-management and metabolic control of type 2 diabetes among African and European-origin patients. Journal of Nursing and Healthcare of Chronic Illness. 2011;3(3):245-56.
29. Mohebi S, Parham M, Sharifirad G, Gharlipour Z, Mohammadbeigi A, Rajati F. Relationship between perceived social support and self-care behavior in type 2 diabetics: A cross-sectional study. Journal of Education and Health Promotion. 2018;7(1):48.
30. Kurnia AD, Amatayakul A, Karuncharernpanit S. Predictors of diabetes self-management among type 2 diabetics in Indonesia: Application theory of the health promotion model. International Journal of Nursing Sciences. 2017;4(3):260-5.
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IssueVol 10 No 1 (2023): Winter QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/npt.v10i1.12256
Keywords
type 2 diabetes mellitus; diabetic foot; foot care behavior; foot care knowledge; self-efficacy

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How to Cite
1.
Cheng Y-J, Masingboon K, Samartkit N, Moungkum S. Factors influencing foot care behavior among patients with type 2 diabetes mellitus who have a high-risk diabetic foot in China. NPT. 2023;10(1):44-52.