SLR - November 2020 - Casey Schofield

Factors Related to Self-Care Behaviors Among Patients with Diabetic Foot Ulcers

Reference: Eun Jo Kim RN, MSc, Kuem-Sun Han PhD, RN. Factors Related to Self-Care Behaviors Among Patients with Diabetic Foot Ulcers. Journal of Clinical Nursing. February 2020

Level of Evidence: 4, Cross-sectional study

Scientific Literature Review

Reviewed By: Casey Schofield, DPM
Residency Program: Southern Arizona VA Healthcare System – Tucson, AZ

Podiatric Relevance: The care and treatment of diabetic foot ulcers (DFU) is a worldwide health problem and comes with various complications. The reoccurrence rate for DFU is up to 59 percent and amputations occur in 34 percent of DFU. Much of the wound care occurs beyond our clinics and there are many factors that promote self-care behaviors. The purpose of this study was to examine the level of self-care behaviors of patients with DFU and identify the influencing factors. 

Methods: This is a cross-section study involving a total of 131 participants in which data was collected from July-August 2018. Demographic information included age, gender, education, marital status and employment. Disease-related knowledge included experience of patient’s diabetic education, length of diagnosis, experience of hospitalizations or its complications, and wound treatment methods. Knowledge of laboratory characteristics were analyzed including WBC, HbA1c, ESR, CRP, ALB and BMI. Self-Care behaviors included diabetic foot care as well as diabetes management i.e. dietary practices, medication adherence, physical exercise and glucose testing. 

Results: Among the influencing factors that promoted self-care behaviors of patients with DFU, the variable that had the greatest effect on diabetic foot care behavior was; experience of diabetic education. This included knowledge about diabetic medication instructions, wearing socks that do not stick to feet and not having their feet be exposed to dangerous temperatures. Other factors that promoted self-care behavior include female gender, males with a spouse or other familiar support. Laboratory characteristics that promoted better self-care included ESR and HbA1c levels. The factors in which participants with DFU scored low on was dietary practices, physical exercise and moisturizing feet and managing foot callus.

Conclusions: The authors conclude the best way to promote self-care behaviors of DFU patients is to focus on patient education of their Diabetes Mellitus. They also agree that laboratory test that effects patients the most is knowledge of HbA1c and ESR levels. Overall, this article may help clinicians understand what factors promote better self-care behavior of patients with DFU. Perhaps spending a more time discussing these promoting factors may reduce the rate of reoccurrence and amputations in the future. 

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