Pre-intervention Evaluation of the Diabetic Foot Care Education Programme
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Efectiveness of the Diabetic Foot Care Programme in a Primary Care Setting
education within the district of LMS. However the degree of implementation varied among clinics from 19 to 100.
The average knowledge score obtained by patients who were exposed to diabetic foot care education was 7.5 SD 2.8. The knowledge score ranged from 5 to 10. The
maximum possible score is 23. This shows that the knowledge of diabetic foot care is still very poor.
For those who had not been exposed to the diabetic foot care education programme, the average knowledge score obtained was 6.8 2.2. Comparing the mean knowledge
between those who were exposed and those who were not exposed to diabetic foot care education, it is shown that it was statistically significant different p=0.04.
Table 1. Distribution of patient exposed to diabetic foot care education programme and knowledge score by clinic
Clinic Total
diabetic patient
A Patient evaluated
Total number
B of
patient C=BA X
100 Total number of
patients exposed to the diabetic foot
care education programme
Mean knowledge score of those who
were exposed to the diabetic foot
care education programme SD
Mean knowledge score of those who
were not exposed to the diabetic foot
care education programme SD
KK Bandar Taiping
3060 63
2.1 12 19.0
9.1 1.7 7.5 2.2
KK Kamunting
739 19
2.6 12 63.2
6.4 3.0 4.3 1.8
KK Pokok Assam
982 10
1.1 3 30.0
6.0 3.5 6.9 2.0
KK Changkat Jering
375 26
7.0 14 53.9
6.0 3.0 4.9 1.6
KK Kuala Sepetang
261 22
8.4 13 60.0
7.6 3.2 6.1 1.5
KK Trong 384
22 5.7
10 45.5 7.9 2.9
6.3 1.9 KK Sungai
Kerang 180
4 2.2
2 50.0 6.0 1.4
4.0 0 KK Batu Kurau
662 31
4.7 12 38.8
8.2 1.6 7.7 1.6
KK Redang Panjang
214 9
4.2 7 77.8
7.0 3.0 2.5 4.9
KK Sungai Bayor
160 4
2.5 4 100.0
10.0 0.8 0 0
TOTAL 7017
210 3.0
89 42.3 7.5 2.8
6.8 2.2 Patient’s score on knowledge of diabetic foot care Maximum total score = 23 points
Urban clinics
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Efectiveness of the Diabetic Foot Care Programme in a Primary Care Setting
92 patients attending urban clinics had a mean knowledge score of 7.2 SD 2.5 while 118 patients attending rural clinics had a mean score of 6.9 2.5. There was
no significant difference in the mean knowledge score between patients residing in rural areas and urban areas. p = 0.443
Table 2 below shows the relationship between patient’s knowledge on diabetic foot care and their demographic data, namely age group, ethnicity, education level,
duration of diabetes and participation in diabetic camp. It is shown that diabetic foot care knowledge in different age group were statistically significant p=0.002.
Patients’ knowledge showed borderline statistical significance for different educational level p=0.05. As for ethnicity, the duration suffering from diabetes
and participation in diabetic camps shows no statistical significance with regards to the patient’s knowledge on diabetic foot care.
Table 2. Patient knowledge based on their age group, ethnicity, education level, duration of diabetes and participation in diabetic camp
Knowledge on diabetic foot care Total
p- values
Very poor Poor
Moderate
Age group 50
6 13.6 31 70.5
7 15.9 44
0.002 50-60
16 22.9 48 68.6
6 8.6 70
61 41 42.7
50 52.1 5 5.2
96 Ethnicity
Malay 41 28.3
90 62.1 14 9.7
145 0.57
Non malay 22 33.8
39 60.0 4 6.2
65 Education
level Not educated
49 31.6 97 62.6
9 5.8 155
0.05 Educated
14 25.5 32 58.2
9 16.4 55
Duration of diabetes
0-5 48 34.5
79 56.8 12 8.6
139 0.09
5-10 12 25.5
33 70.2 2 4.3
47 10
3 12.5 17 70.8
4 16.7 24
Participation in diabetic
camp Attend
23 29.9 46 59.7
8 10.4 77
0.77 Not attend
40 30.1 83 62.4
10 7.5 133
≤5 of knowledge score 6-10 of knowledge score
11-15 of knowledge score
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Efectiveness of the Diabetic Foot Care Programme in a Primary Care Setting
Table 3. Number and distribution of staff trained in diabetic foot care by clinic Total number of
staff in clinic Staff trained in
diabetic foot care Clinic
Number of MAs
Number of Staff Nurses
Number of MAs Number of Staff
Nurses
KK Bandar Taiping 4
5 4 100.0
2 40.0 KK Kamunting
3 1
2 66.7 1 100.0
KK Pokok Assam 3
2 3 100.0
1 50.0 KK Changkat Jering
2 1
1 50.0 1 100.0
KK Kuala Sepetang 2
1 2 100.0
1 100.0 KK Trong
2 1 50.0
0 0 KK Sungai Kerang
2 1 50.0
0 0 KK Batu Kurau
3 3 100.0
00 KK Redang Panjang
2 2 100.0
0 0 KK Sungai Bayor
2 1 50.0
0 0 Total
25 10
20 80.0 6 60.0
Table 3 shows the number of health staff involved in the diabetic foot care programme in the various clinics. Out of the 25 medical assistants, 20 of them were trained in
diabetic foot care. Out of the 10 nurses, 6 of them were trained on diabetic foot care. Only 5 clinics had staff nurses involved in their diabetic foot care programme.
17 equipments were needed to implement diabetic foot care programme in each clinics. Out of the 10 clinics in the district of LMS, only 5 clinics owned all the necessary
equipment to implement the diabetic foot care programme. The remainder had between 1-5 equipments missing.
The scoring of health staff on diabetic foot care demonstration shows that out of 18 staff evaluated, the mean score was 14.1 SD 2.9. The maximum achievable score
is 20, and the minimum achievable score is 10. 16 of them had proper training on diabetic foot care. Mean score for those who were trained was 14.3 SD 2.9 and
those who were not trained was 12.5 SD 2.1. Out of 18 health workers, only 4 of them obtained a good score, 13 moderate score and 1 performed poorly as shown
in the table 4 below.
From the survey done on the 18 health staff, 94.4 and 72.2 of them complained that there wasn’t enough time to examine patient and there was no suitable place to
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Efectiveness of the Diabetic Foot Care Programme in a Primary Care Setting
Table 4. Score performance of trained staff on diabetic foot care demonstration Grade
Total poor
moderate good
Trained trained
1 11
4 16
not trained
2 2
Total
1 13
4 18
Maximum of 21 was achievable from this demonstration
Table 5. Staff opinion on implementing the foot care programme in terms of staffing, resources, facilities, training, communication and cooperation.
Staff Opinions on Implementing the Foot Care Programme
Responses Number
Percentages
Training is beneficial Yes
13 72.2
No Not sure 5
27.8 Adequate and functioning equipment
Yes 13
72.2 No Not sure
5 27.8
Is equipment easy to handle Yes
13 72.2
No Not sure 5
27.8 Enough time to examine patient
Yes 1
5.6 No Not sure
17 94.4
Suitable place for examination Yes
5 27.8
No Not sure 13
72.2 Is communication with patient a barrier
to staff Yes
6 33.3
No Not sure 12
67.7 Is patient cooperating
Yes 14
77.8 No Not sure
4 22.2
Is colleague cooperating Yes
15 83.3
No Not sure 3
16.7 Staff provided during diabetic clinic
adequate Yes
4 22.2
No Not sure 14
77.8 Is supervision done employer
Yes 8
44.4 No Not sure
10 56.6
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Efectiveness of the Diabetic Foot Care Programme in a Primary Care Setting
examine them respectively. 77.8 of the health staff had the opinion that there was insufficient manpower during the diabetic clinic. Less than 50 of them responded
that there was no adequate supervision by the family medicine specialist FMS or medical officer when implementing the diabetic foot care programme. All the results
are shown in Table 5.