JMIR Publications

ABSTRACT

Background:

Diabetic foot ulceration (DFU) is the leading cause of non-traumatic amputations in people with diabetes. Research shows that improving patient awareness can result in short-term improvements, but Cochrane reviews report insufficient high-quality evidence.

Objective:

This study aims to investigate the effects of multi-media presentation and smartphone alerts to enhance long-term knowledge and foot care behaviours in individuals at moderate to high risk of DFU.

Methods:

Participants with moderate-high risk of DFU were randomised to a control group, receiving usual diabetic foot care advice (n=32), or an intervention group, receiving a multi-media diabetic foot care presentation and regular ‘foot alerts' through a smartphone application (MyU) on top of usual diabetic foot care advice (n=34). Patient's knowledge and behaviours of diabetic foot care were assessed at baseline and after 12 months of the intervention.

Results:

There was a significant positive correlation between the number of podiatry visits and the change in foot care behaviour in the intervention group (r= 0.408, p=0.016), while the control group showed a negative correlation (r= -0.402, p=0.022). No significant correlations were observed with the change in knowledge scores. No significant difference in HbA1c at 12 months or in the frequency of new DFU was observed between the two groups. No Time*Group interactions for diabetic foot care knowledge or behaviour were seen but significant main effects of time (F [1,64] =8.760; P2-ANOVA =0.004 for knowledge scores, and F [1,64] =28.139; P2-ANOVA <0.001 for behaviour scores) were observed.

Conclusions:

The study revealed that multi-media education for improving foot self-care knowledge and behaviour is not effective in the long-term in moderate-high DFU risk individuals, but reinforcement of educational material in follow-up podiatry visits could be effective. Clinical Trial: Clinical Trials Registry on October 2, 2019 (NCT03934944); ClinicalTrials.gov