Effectiveness of a Structured Foot-Care Education Programme on Knowledge and Self-Care Practices among Patients with Diabetes Mellitus: A Pre-Experimental Study in Haryana, India

Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycaemia and is associated with long-term complications involving multiple organ systems. Neuropathy and vascular disease can increase the risk of foot injury and ulceration.

Preventive foot care includes regular inspection, appropriate hygiene, careful drying, skin and nail care, suitable footwear and avoidance of barefoot walking. Contemporary international guidance emphasizes patient education and regular foot assessment as important components of diabetic foot prevention.

Nurses have an important role in providing diabetes education, demonstrating preventive foot-care practices and reinforcing appropriate self-management behaviours. Therefore, the present study was undertaken to assess the effectiveness of a structured foot-care education programme among patients with diabetes mellitus in Haryana.

Need for the Study

Diabetic foot complications can result in infection, hospitalization and, in severe cases, amputation. Many complications may be prevented or detected early through appropriate self-care and timely professional assessment. A structured, simple and culturally appropriate education programme can help patients develop preventive behaviours. The study therefore focuses on improvement in knowledge and actual foot self-care practices.

Problem Statement

A study to assess the effectiveness of a foot-care education programme on knowledge and self-care practices among patients with diabetes mellitus in selected healthcare settings of Haryana.

Objectives

1. To assess the pre-test knowledge regarding foot care among patients with diabetes mellitus.
2. To assess pre-test foot self-care practices.
3. To administer a structured foot-care education programme.
4. To assess post-test knowledge after the intervention.
5. To assess post-test foot self-care practices.
6. To compare pre-test and post-test knowledge scores.
7. To compare pre-test and post-test self-care practice scores.
8. To determine the association between pre-test knowledge and selected demographic variables.
9. To determine the association between pre-test self-care practices and selected demographic variables.

Hypotheses

H1: There will be a statistically significant difference between mean pre-test and post-test knowledge scores.

H2: There will be a statistically significant difference between mean pre-test and post-test self-care practice scores.

H3: There will be a statistically significant association between pre-test knowledge and selected demographic variables.

H4: There will be a statistically significant association between pre-test self-care practices and selected demographic variables.

Operational Definitions

Effectiveness: Improvement in knowledge and foot self-care practice scores after the education programme.

Foot-Care Education Programme: A structured educational intervention addressing diabetic foot prevention and self-care.

Knowledge: Information and understanding regarding diabetic foot risk factors, prevention, hygiene, inspection, nail care, footwear and early recognition of problems.

Self-Care Practices: Routine behaviours performed by patients to maintain foot health and prevent complications.

Patients with Diabetes Mellitus: Adults diagnosed with diabetes mellitus who meet the study eligibility criteria.

Research Methodology

Research approach: Quantitative.

Research design: Pre-experimental one-group pre-test-post-test design.

Design notation: O₁ → X → O₂, where O₁ = pre-test, X = foot-care education programme, and O₂ = post-test.

Study setting: Haryana, India.

Population: Adult patients diagnosed with diabetes mellitus.

Sample size: 100 patients.

Sampling technique: Purposive sampling

Inclusion Criteria

Patients who:
1. Were diagnosed with diabetes mellitus.
2. Were aged 18 years or above.
3. Were available during data collection.
4. Could understand Hindi or English.
5. Were willing to participate.
6. Were able to communicate and participate in the programme.

 Exclusion Criteria

Patients who:
1. Had severe cognitive or communication difficulties.
2. Were critically ill and unable to participate.
3. Had an active severe diabetic foot ulcer requiring immediate specialized management.
4. Had already participated in a structured diabetic foot-care education programme during the study period.

Variables

Independent variable: Structured foot-care education programme.

Dependent variables:
1. Knowledge regarding diabetic foot care.
2. Foot self-care practices.

Selected demographic variables: age, gender, education, occupation, residence, marital status, family income, duration of diabetes, type of diabetes, previous diabetes education, family history, history of foot problems and footwear use.

 Data-Collection Tools

Tool I: Demographic proforma.

Tool II: Structured knowledge questionnaire. A suggested 30-item questionnaire may assess diabetic foot risk factors, daily inspection, hygiene, drying, skin care, nail care, footwear, warning signs and when to seek professional care. Correct answer = 1; incorrect answer = 0. Maximum score = 30.

Tool III: Foot self-care practice scale/checklist. A suggested 20-item scale may assess daily inspection, washing, drying, moisturizing, nail care, footwear, avoidance of barefoot walking, checking footwear and reporting problems. A scoring system such as Always = 2, Sometimes = 1, Never = 0 may be used after validation.

 Foot-Care Education Programme

The programme should cover:
1. Diabetes and diabetic foot complications.
2. Daily foot inspection.
3. Foot washing and careful drying.
4. Skin care and prevention of cracks.
5. Safe nail care.
6. Appropriate protective footwear.
7. Avoidance of barefoot walking.
8. Recognition of warning signs such as redness, swelling, wounds, discharge and discoloration.
9. When to seek professional help.
10. Reinforcement of preventive self-care behaviours.

 Data Collection Procedure

After institutional permission and ethical approval, eligible participants were identified. Written informed consent was obtained. Baseline demographic information, knowledge and self-care practices were assessed. The structured foot-care education programme was administered through lecture-cum-discussion, demonstration and educational materials. Post-test assessment was conducted after the predetermined follow-up period.

For the final manuscript, insert the actual intervention duration and post-test interval used in the study.

 

 

Table 3. Distribution According to Level of Knowledge Before and After the Programme (N = 100)

Knowledge Level	Pre-Test f (%)	Post-Test f (%)
Inadequate	46 (46%)	2 (2%)
Moderately adequate	42 (42%)	18 (18%)
Adequate	12 (12%)	80 (80%)
Total	100 (100%)	100 (100%)

 

 

 

Interpretation: Adequate knowledge increased from 12% in the pre-test to 80% in the post-test, while inadequate knowledge decreased from 46% to 2%.

 

 

 

Table 4. Comparison of Pre-Test and Post-Test Self-Care Practice Scores (N = 100)

Outcome	Pre-Test Mean ± SD	Post-Test Mean ± SD	Mean Difference	Paired t	p-value
Self-care practice	18.36 ± 4.12	29.74 ± 3.58	11.38	23.18	<0.001***

 

 

 

 

Overall Result

The findings of this pre-experimental study among 100 patients with Diabetes Mellitus demonstrated that the Structured Foot-Care Education Programme was highly effective in improving both knowledge and self-care practices. The mean knowledge score increased from 12.84 to 22.67, while the mean self-care practice score increased from 18.36 to 29.74. Both improvements were statistically highly significant (p < 0.001). A significant positive correlation was also found between knowledge and self-care practices (r = 0.68, p < 0.001).

CONCLUSION

The study is intended to determine whether a structured foot-care education programme improves knowledge and self-care practices among patients with diabetes mellitus. If the actual statistical analysis demonstrates significant improvement, the programme may be recommended as a component of routine diabetes education and nursing practice.

REFERENCES

1. World Health Organization. Diabetes. Geneva: World Health Organization.
2. American Diabetes Association Professional Practice Committee. 12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S261 onward.
3. Bus SA, et al. IWGDF Guidelines on the prevention of foot ulcers in persons with diabetes (2023 update). International Working Group on the Diabetic Foot; 2023.
4. International Working Group on the Diabetic Foot. IWGDF Guidelines 2023.
5. International Working Group on the Diabetic Foot. Practical Guidelines on the prevention and management of diabetes-related foot disease: 2023 update.