JMIR Publications

ABSTRACT

Background:

Diabetes mellitus can lead to severe and debilitating foot complications, such as infections, ulcerations, and amputations. Despite substantial progress in diabetes care, foot disease remains a major challenge in managing this chronic condition that causes serious health complications worldwide.

Objective:

The primary aim of this study was to examine the feasibility and usability of a telehealth program focused on preventive diabetes foot care. A secondary aim was to descriptively measure self-reported changes in diabetes knowledge, self-regulation, and foot care behaviors before and after participating in the program.

Methods:

The study used a single-arm, pre-post design in two large family medical practice clinics in Texas. Participants met individually with the nurse practitioner once a month for 3 months using synchronous telehealth videoconferencing. Each participant received diabetes foot education guided by the Integrated Theory of Health Behavior Change. Feasibility was measured with rates of enrollment and program and assessment completion. Usability was measured with the Telehealth Usability Questionnaire (TUQ). Diabetes knowledge, self-regulation, and foot care were measured with validated survey instruments at baseline, 1.5 months, and 3 months.

Results:

Of 50 eligible individuals, 39 (78%) enrolled; 34/39 (87%) completed the first videoconference, and 29/39 (74%) completed the second and third videoconferences. Of the 39 consented, 37 (95%) completed the baseline assessment; 50% (17/34) of those who attended the first videoconference completed the assessment at 1.5 months, and 100% (29/29) of those who attended the subsequent videoconferences completed the final assessment. Overall, participants reported a positive attitude toward the use of telehealth, with a mean TUQ score of 6.24 (SD = 0.98) on a 7-point scale. At baseline, the mean diabetes knowledge score was 70.48 (SD = 17.86) out of 100. At 1.5 months and 3 months, the mean score was 75.92 (SD = 15.81) and 83.89 (SD = 10.70), respectively. The values for Summary of Diabetes Self-Care Activities demonstrated better self-regulation, with an increase in the number of days out of the week (d/w) that participants adhered to foot care before compared to after participating in the telehealth program (+1.71 d/w), healthy eating habits (+1.4 d/w), and physical activity recommendations (+1.13 d/w). The frequency of self-reported foot examination and care behaviors also improved. Out of possible scores from 7 to 35, the mean scores for foot care increased from 17.75 (SD = 7.42) at baseline to 25.46 (SD = 6.20) at 3 months.

Conclusions:

This study demonstrates that a nurse-led telehealth educational program centered on diabetes foot care is feasible, acceptable, and has the potential to improve diabetes knowledge and self-regulation that are precursors to preventing debilitating foot complications.