Short-term effectiveness of a culturally tailored educational intervention on foot self-care among type 2 diabetes patients in Morocco

Abstract

BackgroundSelf-management education (SME) is an important yet unacknowledged aspect of diabetes care. Despite the raise of diabetes and its complications with significant burden in developing countries, research on SME interventions in Morocco is lacking.AimsTo assess the effectiveness of a culturally tailored SME intervention on foot-care self-management practices among type 2 diabetes patients and to identify factors associated with practices variation.MethodsWe designed a pre-post prospective quasi-experimental study and recruited patients with type 2 diabetes aged 30 years old or above. The intervention consisted of an interactive group discussion using different materials: a narrative video, a PowerPoint presentation and a printed guide. Foot-care practices were assessed prior to the session and one month later using 2 items from the Summary of Diabetes Self-Care Activities (SDSCA). Binary logistic regression was performed to identify factors associated with a favorable variation, defined as an increase in the mean frequency score of foot-care by a minimum of 1 day/week.ResultsA total of 199 participants were recruited and 133 completed the second assessment. Mean age was 55.2 ± 11.2 years old. Women represented 67% and 72% of participants was illiterate. The foot-care score mean increased from 3.5 ± 2.9 days to 5.9 ± 1.8 days one month after the intervention (mean variation was 2.4 ± 3.1 days; p < 0.001). A favorable variation was found among 75 (37.7%) participants. In multivariate analysis, literacy was associated with higher likelihood of a favorable variation of foot-care practices (OR = 2.82; 95%CI: 1.09–7.31) while previous education about diabetic foot was associated with lower likelihood of a favorable variation (OR = 0.26; 95%CI: 0.08–0.78).ConclusionsThere was a general improvement in foot-care practices after the intervention. Our findings suggest the role of literacy and previous patient education in shaping the observed variation. Culturally tailored interventions targeting other disease management domains are needed in our context.

Literacy in health and self-care in people with type 2 diabetes mellitus

“…Women were more prevalent in this study, a similar profile to the Brazilian projection of the population of women, which in 2030 will correspond to 50.6% of the total population (21) . We also note that women tend to use health services more often than men (22) .…”

“…Therefore, to prevent diabetic foot, strict bloodglucose control and appropriate foot care are required, such as daily and systematic inspection of the feet and of the inside of the shoes. For developing countries, factors related to poverty, literacy and environmental barriers delay the seeking for therapy and lower priority given to foot care by patients and health professionals have been cited as the main contributory factors that may lead to increases in the risk of complications in the feet (22) .…”

Beliefs and practices in diabetes care

“…It is important to tell the patient that they must inspect shoes before use them, wear cotton socks, not to use chemical substances nor elastic bands, control the temperature of the bathwater, not to use new shoes for a long period to prevent injuries [55][56][57][58] .…”

Development and testing of a new electronic foot health promotion programme on nurses’ foot self-care

“…Educational interventions were provided in groups [16][17][18] and in face-to-face settings [16,17]. They were reinforced by written material [14], lectures and meetings with health-care professionals [14,19] or periodic support and foot checks [20]. The individual sessions varied from 20 min [21] to 90 min [16], and the full interventions lasted from 20 min [21] to 4 weeks [14].…”

“…Previous studies of foot self-care have focused on patients with long-term health problems [19]. However, little is known about foot self-care in professionals whose feet are exposed to stress for long periods in their daily work environment.…”