The Effects of Diabetic Foot Care Education on Assessments and Behaviors among Adults with Diabetes Mellitus Experiencing Homelessness

Adults with diabetes mellitus experiencing homelessness are at risk for preventable diabetic foot complications, including diabetic foot ulcers and non-traumatic lower extremity amputation. Several risk factors such as the lack of routine healthcare, insurance, nutritious meals, and access to diabetic foot self-care education, impact the individual’s risk for developing diabetic foot ulcers which may lead to non-traumatic lower extremity amputations. The purpose of the study was to measure the effects of RN-led diabetic foot self-care education on the participants’ perceived risks for diabetic foot ulcer or amputation, diabetic foot self-care behaviors, and clinical diabetic foot assessments. The aims of the study were to increase the participant’s knowledge and ability to recognize their individual risk factors for developing diabetic foot ulcer (DFU) and amputation and to decrease the participant’s risk for diabetic foot ulcer and increase the participant’s knowledge of diabetic foot self-care behaviors. A quasi-experimental single group repeated measures design was instituted to meet the aims of the study. The Diabetes Foot: Risk Assessment Education Program was utilized and presented over a period of four-weeks. The educational intervention focused on DFU and/or amputation risk identification and reduction and promoted five daily diabetic foot self-care behaviors to reduce risk for diabetic foot complications. Thirty individuals meeting inclusion criteria enrolled in the study, and twenty completed the four-week study. The dependent variables consisted of perceived DFU or amputation risk, diabetic foot self-care behaviors, and diabetic foot assessments. Based upon the findings, the participants accurately identified their individual risk factors for DFU or amputation. The risk factors consisted of loss of protective sensation, foot deformity and/or a previous DFU and/or amputation and no difference was noted between the pretest and posttest measures. The educational intervention was effective to increase two diabetic foot self-care behaviors from baseline to the remaining weeks of the intervention. Behavioral change was statistically significant for check feet and look in shoes, as assessed by the diabetic foot self-care behaviors on the Summary of Diabetic Self-Care Activities. The behaviors of wash feet, soak feet, and dry between the toes did not change. The Inlow’s 60-Second Diabetic Foot Screen was used for the foot assessments. The educational intervention was not effective to change diabetic foot assessment total scores. The diabetic foot self-care education had a small to moderate effect on two diabetic foot self-care behaviors. Additional studies are needed which focus on the reduction of diabetic foot complications among adults with diabetes mellitus experiencing homelessness.