This systematic review and meta-analysis aimed to synthesize randomized controlled trials on the impact of foot care education on knowledge, self-efficacy and behavior in patients with diabetes. A search was made using PubMed, Web of Science, Science Direct, Google Scholar, YOK National Thesis Center and Google Scholar electronic databases for studies published between March 2003-January 2022. The search medical subject headings (MeSH) terms were diabetic foot, knowledge, self-efficacy, and behavior. Studies suitable for the systematic review and the meta-analysis met the following criteria (PICOS): target participants would be diagnosed with diabetes (population), diabetic foot education (intervention), comparison of the group receiving diabetic foot care education and routine care education, and the control group receiving only routine care education (comparison), studies evaluating the levels of knowledge, self-efficacy and behavior (outcome), randomized controlled trials (study design). Twenty-six studies were included in systematic review. Three studies for knowledge, 5 studies for behavior, 8 studies for self-efficacy were included in the meta-analysis (total sample: 2534, experiment: 1464, control: 1071). All of the studies had low reporting bias. The mean duration of educations for knowledge was 5.2 months. This duration was 4.8 months for behavior and 4.5 months for self-efficacy. In the random effect (since the homogeneity test: P < .001, this model was used), there were significantly difference in terms of knowledge (standardized mean difference (SMD): 1.656, 95% [CI]: 1.014-2.299, P < .001), and behavior (SMD: 1.045, 95% CI: 0.849-1.242, P < .001). But no difference was observed in terms of self-efficacy (SMD: 0.557, 95%CI: −0.402-1.517, P > .05). The results of a systematic review of twenty-six studies and a meta-analysis of 9 studies showed that diabetic foot education improved the level of knowledge and behavior of patients with diabetes, while not affecting their self-efficacy. Educational interventions with long-term follow-up are needed to address the growing health care needs of patients with diabetes.
International Diabetes Foundation. IDF Diabetes Atlas 2019. 2019.
2.
AvogaroAFadiniGP. Microvascular complications in diabetes: a growing concern for cardiologists. Int J Cardiol. 2019;291:29‐35. doi:10.1016/j.ijcard.2019.02.030.
3.
ZhouCByardRW. An analysis of the morbidity and mortality of diabetes mellitus in a forensic context. J Forensic Sci. 2018;63(4):1149‐1154. doi:10.1111/1556-4029.13674.
4.
American Diabetes Association. Microvascular complications and foot care: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(Suppl 1):S151‐S167. doi:10.2337/dc21-S011
5.
ArshadMAArshadSArshadS, et al.The quality of life in patients with diabetic foot ulcers. J Diabetes Metab. 2020;11(2):1‐2. doi:10.35248/2155-6156.20.11.E101.
ValensiPGirodIBaronF, et al.Quality of life and clinical correlates in patients with diabetic foot ulcers. Diabetes Metab. 2005;31(3 I):263‐271. doi:10.1016/S1262-3636(07)70193-3.
8.
PengMZhouQFuX, et al.Health economic indicators in patients with diabetic foot: outpatient multidisciplinary management. Int J Low Extrem Wounds. 2022;21(1):50‐56. doi:10.1177/1534734620923439.
9.
OksuzEMalhanSSonmezB, et al.Cost of illness among patients with diabetic foot ulcer in Turkey. World J Diabetes. 2016;7(18):462‐469. doi:10.4239/wjd.v7.i18.462.
10.
BusSAVan NettenJJLaveryLA, et al.IWGDF Guidance on the Prevention of Foot Ulcers in At-Risk Patients with Diabetes. 2015.
11.
McinnesAJeffcoateWVileikyteL, et al.Foot care education in patients with diabetes at low risk of complications: a consensus statement. Diabet Med. 2011;28(2):162‐167. doi:10.1111/j.1464-5491.2010.03206.x.
12.
WuSFVLeeMCLiangSY, et al.Effectiveness of a self-efficacy program for persons with diabetes: a randomized controlled trial. Nurs Heal Sci. 2011;13(3):335‐343. doi:10.1111/j.1442-2018.2011.00625.x.
13.
SchmidtSMayerHPanfilEM. Diabetes foot self-care practices in the German population. J Clin Nurs. 2008;17(21):2920‐2926. doi:10.1111/j.1365-2702.2008.02352.x.
14.
YücelFSunayD. Diyabetik Hastaların Diyabetik Ayak ve Ayak Bakımıyla İlgili Bilgi, Tutum ve Davranışlarının Değerlendirilmesi. Ankara Med J. 2016;16(3):270‐284. doi:10.17098/amj.53438.
15.
KayaH. Hasta Eğitimi. In: Aşti AT and Karadağ A (eds) Hemşirelik Esasları Hemşirelik Bilim ve Sanatı. Akademi Basın ve Yayıncılık, 2017, p.235.
16.
ShokoohiMNedjatSMajdzadehR. A social network analysis on clinical education of diabetic foot. J Diabetes Metab Disord. 2013;12(1):44. doi:10.1186/2251-6581-12-44.
17.
EldorRRazIYehudaAB, et al.New and experimental approaches to treatment of diabetic foot ulcers: a comprehensive review of emerging treatment strategies. Diabet Med. 2004;21(11):1161‐1173. doi:10.1111/j.1464-5491.2004.01358.x.
18.
HingoraniALamuragliaGMHenkeP, et al.The management of diabetic foot: a clinical practice guideline by the society for vascular surgery in collaboration with the American podiatric medical association and the society for vascular medicine. J Vasc Surg. 2016;63(2):3S‐21S. doi:10.1016/j.jvs.2015.10.003.
19.
LiberatiAAltmanDGTetzlaffJ, et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62:e1‐e34. Pergamon. doi:10.1016/j.jclinepi.2009.06.006.
20.
ShusterJJ. Review: cochrane handbook for systematic reviews for interventions, version 5.1.0, published 3/2011. Julian P.T. Higgins and Sally Green, Editors. Res Synth Methods. 2011;2(2):126‐130. doi:10.1002/jrsm.38.
21.
HigginsJPThomasJChandlerJ,et al.Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons; 2019.
22.
HigginsJPTThompsonSG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539‐1558. doi:10.1002/SIM.1186.
23.
BiçerEKEnçN. Evaluation of foot care and self-efficacy in patients with diabetes in Turkey: an interventional study. Int J Diabetes Dev Ctries. 2016;36(3):334‐344. doi:10.1007/S13410-016-0464-Y.
24.
BeiranvandSFayaziSAsadizakerM. Effect of educational programs on the knowledge, attitude, and practice of foot care in patients with diabetes. Jundishapur J Chronic Dis Care. 2015;4(2). doi:10.5812/jjcdc.26540.
25.
GhoreishiMSVahedian-shahroodiMJafariA, et al.Self-care behaviors in patients with type 2 diabetes: education intervention base on social cognitive theory. Diabetes Metab Syndr Clin Res Rev. 2019;13(3):2049‐2056. doi:10.1016/j.dsx.2019.04.045.
26.
BorgesWJOstwaldSK. Behaviors with Pies Sanos. West J Nurs Res. 2008;30(3):325‐341.
27.
FanLSidaniSCooper-BrathwaiteA, et al.Improving foot self-care knowledge, self-efficacy, and behaviors in patients with type 2 diabetes at low risk for foot ulceration: a pilot study. Clin Nurs Res. 2014;23(6):627‐643. doi:10.1177/1054773813491282.
LeeS-KShinD-HKimY-H, et al.Effect of Diabetes Education Through Pattern Management on Self-Care and Self-Efficacy in Patients with Type 2 Diabetes. doi:10.3390/ijerph16183323.
32.
WichitNMnatzaganianGCourtneyM, et al.Randomized controlled trial of a family-oriented self-management program to improve self-efficacy, glycemic control and quality of life among Thai individuals with type 2 diabetes. Diabetes Res Clin Pract. 2017;123:37‐48. doi:10.1016/j.diabres.2016.11.013.
33.
JiangXJJiangHLuYH, et al.The effectiveness of a self-efficacy-focused structured education programme on adults with type 2 diabetes: a multicentre randomised controlled trial. J Clin Nurs. 2019;28(17-18):3299‐3309. doi:10.1111/JOCN.14908.
34.
WallaceASSeligmanHKDavisTC, et al.Literacy-appropriate educational materials and brief counseling improve diabetes self-management. Patient Educ Couns. 2009;75(3):328‐333. doi:10.1016/J.PEC.2008.12.017.
35.
KangCChangSChenP, et al. Comparison of family partnership intervention care vs. conventional care in adult patients with poorly controlled type 2 diabetes in a community hospital: a randomized. Elsevier, https://www.sciencedirect.com/science/article/pii/S0020748910001112 (accessed 29 April 2022).
36.
HailuFBMoenAHjortdahlP. Diabetes self-management education (DSME)—effect on knowledge, self-care behavior, and self-efficacy among type 2 diabetes patients in Ethiopia: a controlled clinical trial. Diabetes, Metab Syndr Obes Targets Ther. 2019;12:2489. doi:10.2147/DMSO.S223123.
37.
PeimaniMMonjazebiFGhodssi-GhassemabadiR, et al.A peer support intervention in improving glycemic control in patients with type 2 diabetes. Patient Educ Couns. 2018;101(3):460‐466. doi:10.1016/j.pec.2017.10.007.
38.
MarchandCMargatADeccacheC, et al.Evaluation of two therapeutic patient education programs for prevention of diabetic foot ulcers. Educ Thérapeutique du Patient—Ther Patient Educ. 2018;10(1):10201. doi:10.1051/tpe/2018004.
39.
KilicMKaradağA. Developing and evaluating a mobile foot care application for persons with diabetes mellitus: a randomized pilot study. Wound Manag Prev. 2020;66(10):29‐40. doi:10.25270/wmp.2020.10.2940.
40.
RahamanHSKJyotsnaVPSreenivasV, et al.Effectiveness of a patient education module on diabetic foot care in outpatient setting: an open-label randomized controlled study. Indian J Endocrinol Metab. 2018;22(1):74‐78. doi:10.4103/ijem.IJEM_148_17.
41.
CicekSCGokdoganF. Effect of education and monitoring on developing foot care of elderly with diabetes mellitus. Clin Exp Heal Sci. 2021;11:471‐480. doi:10.33808/clinexphealthsci.815251.
42.
Ahmad SharoniSKAbdul RahmanHMinhatHS, et al.The effects of self-efficacy enhancing program on foot self-care behaviour of older adults with diabetes: a randomised controlled trial in elderly care facility, peninsular Malaysia. PLoS One. 2018;13(3):e0192417. doi:10.1371/journal.pone.0192417.t006.
43.
CorbettCF. A randomized pilot study of improving foot care in home health patients with diabetes. Diabetes Educ. 2003;29(2):273‐282.
44.
VedharaKBeattieAMetcalfeC, et al.Development and preliminary evaluation of a psychosocial intervention for modifying psychosocial risk factors associated with foot re-ulceration in diabetes. Behav Res Ther. 2012;50(5):323‐332. doi:10.1016/J.BRAT.2012.02.013.
45.
AzamiGSohKLSazlinaSG, et al.Effect of a nurse-led diabetes self-management education program on glycosylated hemoglobin among adults with type 2 diabetes. J Diabetes Res. 2018;2018, doi:10.1155/2018/4930157.
46.
HermannsNKulzerBEhrmannD, et al.The effect of a diabetes education programme (PRIMAS) for people with type 1 diabetes: results of a randomized trial. Diabetes Res Clin Pract. 2013;102(3):149‐157. doi:10.1016/j.diabres.2013.10.009.
47.
WishahRAAl-KhawaldehOAAlbsoulAM. Impact of pharmaceutical care interventions on glycemic control and other health-related clinical outcomes in patients with type 2 diabetes: randomized controlled trial. Diabetes Metab Syndr Clin Res Rev. 2015;9(4):271‐276. doi:10.1016/j.dsx.2014.09.001.
48.
DincerBBahçecikN. The effect of a mobile application on the foot care of individuals with type 2 diabetes: a randomised controlled study. Health Educ J. 2021;80(4):425‐437. doi:10.1177/0017896920981617.
49.
ZhouYDendukuriN. Statistics for quantifying heterogeneity in univariate and bivariate meta-analyses of binary data: the case of meta-analyses of diagnostic accuracy. Stat Med. 2014;33(16):2701‐2717. doi:10.1002/sim.6115.
50.
Ahmad SharoniSKMinhatHSMohd ZulkefliNA, et al.Health education programmes to improve foot self-care practices and foot problems among older people with diabetes: a systematic review. Int J Older People Nurs. 2016;11(3):214‐239. doi:10.1111/opn.12112.
51.
van NettenJJBabaMLazzariniPA. Epidemiology of diabetic foot disease and diabetes-related lower-extremity amputation in Australia: a systematic review protocol. Syst Rev. 2017;6(1). doi:10.1186/s13643-017-0488-5.
52.
AlrubAAHyassatDKhaderYS, et al.Factors associated with health-related quality of life among Jordanian patients with diabetic foot ulcer. J Diabetes Res. 2019;2019, doi:10.1155/2019/4706720.
53.
TcheroHKangambegaPLinL, et al.Cost of diabetic foot in France, Spain, Italy, Germany and United Kingdom: a systematic review. Ann Endocrinol (Paris). 2018;79(2):67‐74. doi:10.1016/j.ando.2017.11.005.
54.
GoodallRJEllauziJTanMKH, et al.A systematic review of the impact of foot care education on self efficacy and self care in patients with diabetes. Eur J Vasc Endovasc Surg. 2020;60(2):282‐292. doi:10.1016/j.ejvs.2020.03.053.
55.
YangözŞTÖzerZ. The effect of music intervention on patients with cancer-related pain: a systematic review and meta-analysis of randomized controlled trials. J Adv Nurs. 2019;75(12):3362‐3373. doi:10.1111/jan.14184.
56.
BoutronIMoherDAltmanDG, et al.Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148(4):295‐309. doi:10.7326/0003-4819-148-4-200802190-00008.
57.
ThorudJCPlemmonsBBuckleyCJ, et al.Mortality after nontraumatic major amputation among patients with diabetes and peripheral vascular disease: a systematic review. J Foot Ankle Surg. 2016;55(3):591‐599. doi:10.1053/j.jfas.2016.01.012.
58.
NorrisSLLauJSmithSJ, et al.Self-management education for adults with type 2 diabetes. A meta-analysis of the effect on glycemic control. Diabetes Care. 2002;25(7):1159‐1171. doi:10.2337/diacare.25.7.1159.
59.
DorresteijnJANKriegsmanDMWAssendelftWJJ, et al.Patient education for preventing diabetic foot ulceration. Cochrane Database Syst Rev. 2014;2014(12). doi:10.1002/14651858.CD001488.pub5.
TanEKhooJGaniLU, et al.Effect of multidisciplinary intensive targeted care in improving diabetes mellitus outcomes: a randomized controlled pilot study—the integrated diabetes education, awareness and lifestyle modification in Singapore (IDEALS) program. Trials. 2019;20(1). doi:10.1186/s13063-019-3601-3.
62.
NemcováJHlinkováE. The efficacy of diabetic foot care education. J Clin Nurs. 2014;23(5-6):877‐882. doi:10.1111/jocn.12290.
63.
ChrvalaCASherrDLipmanRD. Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient Educ Couns. 2016;99(6):926‐943. doi:10.1016/j.pec.2015.11.003.
64.
Gleeson-KreigJAM. Self-monitoring of physical activity: effects on self-efficacy and behavior in people with type 2 diabetes. Diabetes Educ. 2006;32(1):69‐77. doi:10.1177/0145721705284285.
65.
KartalG. The Effect of Cognitive and Metacognitive Strategies on Self-Efficacy Beliefs of Freshman EFL Students.
66.
GökdenizDAkgün ŞahinZ. Evaluation of knowledge levels about diabetes foot care and self-care activities in diabetic individuals. Int J Low Extrem Wounds. 2022;21(1):65‐74. doi:10.1177/1534734620926266.
67.
PerrinBMSwerissenHPayneC. The association between foot-care self efficacy beliefs and actual foot-care behaviour in people with peripheral neuropathy: a cross-sectional study. J Foot Ankle Res. 2009;2(1):3. doi:10.1186/1757-1146-2-3.
68.
BinningJWoodburnJBusSA, et al.Motivational interviewing to improve adherence behaviours for the prevention of diabetic foot ulceration. Diabetes Metab Res Rev. 2019;35(2). doi:10.1002/dmrr.3105.
69.
ChenHCaiCXieJ, et al.The effect of an intensive patients’ education program on anxiety, depression and patient global assessment in diabetic foot ulcer patients with Wagner grade 1/2: a randomized, controlled study. Med (United States). 2020;99(6). doi:10.1097/MD.0000000000018480.
70.
WukichDKRaspovicKMSuderNC. Patients with diabetic foot disease fear major lower-extremity amputation more than death. Foot Ankle Spec. 2018;11(1):17‐21. doi:10.1177/1938640017694722.
71.
ChaiSYaoBXuL, et al.The effect of diabetes self-management education on psychological status and blood glucose in newly diagnosed patients with diabetes type 2. Patient Educ Couns. 2018;101(8):1427‐1432. doi:10.1016/j.pec.2018.03.020.
72.
MakilingMSmartH. Patient-centered health education intervention to empower preventive diabetic foot self-care. Adv Ski Wound Care. 2020;33(7):360‐365. doi:10.1097/01.ASW.0000666896.46860.d7.
73.
SinghSJajooSShuklaS, et al.Educating patients of diabetes mellitus for diabetic foot care. J Fam Med Prim Care. 2020;9(1):367. doi:10.4103/jfmpc.jfmpc_861_19.
