A Nurse-Led Telehealth Program for Diabetes Foot Care: Feasibility and Usability Study

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-care, and foot care behaviors before and after participating in the program. Methods The study used a single-arm, pre-post design in 2 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. Diabetes knowledge, self-care, and foot care behaviors were measured with validated survey instruments at baseline, 1.5 months, and 3 months. Results Of 50 eligible individuals, 39 (78%) enrolled; 34 of 39 (87%) completed the first videoconference and 29 of 39 (74%) completed the second and third videoconferences. Of the 39 who 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 Telehealth Usability Questionnaire score of 6.24 (SD 0.98) on a 7-point scale. Diabetes knowledge increased by a mean of 15.82 (SD 16.69) points of 100 (P<.001) from baseline to 3 months. The values for the Summary of Diabetes Self-Care Activities measure demonstrated better self-care, with participants performing foot care on average 1.74 (SD 2.04) more days per week (P<.001), adhering to healthy eating habits on average 1.57 (SD 2.12) more days per week (P<.001), and being physically active on average 1.24 (SD 2.21) more days per week (P=.005). Participants also reported an improvement in the frequency of foot self-examinations and general foot care behaviors. The mean scores for foot care increased by a mean of 7.65 (SD 7.04) points (scale of 7 to 35) from baseline to 3 months postintervention (P<.001). 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-care, which are precursors to preventing debilitating foot complications.

Enhancing foot care education and support strategies in adults with type 2 diabetes

“…A subgroup of 29 individuals from the parent study participated in the qualitative interviews (Ju et al, 2023).…”

“…We conducted a descriptive qualitative study nested within a pre–post feasibility study design evaluating a 3-month telehealth-delivered educational program on diabetes foot care ( Ju et al, 2023 ). The parent study investigated the feasibility of providing a theory-based diabetes education, specifically emphasizing preventive foot care practices, to people with type 2 diabetes mellitus using synchronous telehealth technology ( Ju et al, 2023 ). Enrollment, assessment, and program completion rates were obtained to determine the feasibility of the telehealth initiative ( Ju et al, 2023 ).…”

“…The parent study investigated the feasibility of providing a theory-based diabetes education, specifically emphasizing preventive foot care practices, to people with type 2 diabetes mellitus using synchronous telehealth technology ( Ju et al, 2023 ). Enrollment, assessment, and program completion rates were obtained to determine the feasibility of the telehealth initiative ( Ju et al, 2023 ). At baseline, 1.5 months, and 3 months, the Telehealth Usability Questionnaire ( Parmanto et al, 2016 ), Diabetes Knowledge Scale ( D'Eramo-Melkus et al, 1992 ), Summary of Diabetes Self-Care Activities ( Toobert et al, 2000 ), and Diabetes Foot Self-Care Behavior Scale ( Chin & Huang, 2013 ) were used to examine telehealth usability, diabetes knowledge, self-care practices, and foot care behaviors, respectively ( Ju et al, 2023 ).…”

“…Enrollment, assessment, and program completion rates were obtained to determine the feasibility of the telehealth initiative ( Ju et al, 2023 ). At baseline, 1.5 months, and 3 months, the Telehealth Usability Questionnaire ( Parmanto et al, 2016 ), Diabetes Knowledge Scale ( D'Eramo-Melkus et al, 1992 ), Summary of Diabetes Self-Care Activities ( Toobert et al, 2000 ), and Diabetes Foot Self-Care Behavior Scale ( Chin & Huang, 2013 ) were used to examine telehealth usability, diabetes knowledge, self-care practices, and foot care behaviors, respectively ( Ju et al, 2023 ). Each participant had synchronous telehealth videoconferences with the nurse practitioner once a month for 3 months ( Ju et al, 2023 ).…”

“…At baseline, 1.5 months, and 3 months, the Telehealth Usability Questionnaire ( Parmanto et al, 2016 ), Diabetes Knowledge Scale ( D'Eramo-Melkus et al, 1992 ), Summary of Diabetes Self-Care Activities ( Toobert et al, 2000 ), and Diabetes Foot Self-Care Behavior Scale ( Chin & Huang, 2013 ) were used to examine telehealth usability, diabetes knowledge, self-care practices, and foot care behaviors, respectively ( Ju et al, 2023 ). Each participant had synchronous telehealth videoconferences with the nurse practitioner once a month for 3 months ( Ju et al, 2023 ). Diabetes foot education, guided by the Integrated Theory of Health Behavior Change, was provided to each participant ( Ju et al, 2023 ).…”