A study to assess the Knowledge, expressed Practice and Attitude regarding Diabetic Foot care in patient with Diabetes at Mathura Das Mathur Hospital Jodhpur

Barkha Blossam Francis¹, Mukesh Tetarwal², Murli Dhar Sharma³

¹Final Year M.Sc. Nursing Student, Government College of Nursing, Jodhpur.

²Principal, Government College of Nursing, Jodhpur.

³HOD MSN Department, Government College of Nursing, Jodhpur.

*Corresponding Author E-mail: barkhablossam@gmail.com

ABSTRACT:

This study was to assess the knowledge, expressed practice and attitude regarding diabetic foot care in patient with diabetes “A study to assess the knowledge, expressed practice and attitude regarding diabetic foot care in patient with diabetes at Mathura Das Mathur Hospital Jodhpur” was conducted by Barkha Blossam Francis at Government College of Nursing, Jodhpur. 100 samples were selected using Non – probability convenient sampling technique The knowledge used questionnaire, practice checklist, attitude scale method to assess the knowledge, expressed practice and attitude regarding diabetic foot care in patient with diabetes. The majority of samples 49% had poor knowledge, 39% had good practice score and 46% had favorable attitude in the diabetic foot care in patient with diabetes mellitus. Data showed that that there is no relation found between the knowledge regarding diabetic foot care among patients with diabetes mellitus with the selected demographical variables, in terms of gender, religion, area of living, duration of illness diagnosed, type of diabetes, presence of diabetic complications, with the selected demographical variables. And there is relation found between knowledge regarding diabetic foot care among patients with diabetes mellitus with expressed practice and attitude of diabetic patient. There is positive correlation between knowledge, expressed practice and attitude of diabetes patients.

KEYWORDS: Assess, Knowledge, Practice, Attitude, Diabetic Foot Care, Diabetes.

INTRODUCTION:

The diabetic foot syndrome or disease includes several pathologies, mainly diabetic peripheral neuropathy and peripheral arterial disease which result in foot ulceration. Diabetic foot ulceration may ultimately lead to amputation, especially when wound infection or osteomyelitis is involved. It defined as a full-thickness wound which is present at a level distal to the ankle in patients with diabetes. Losing a limb is a great loss for anyone and also create mental imbalance.

Diabetic foot ulcer if not treated ends up with amputation of lower limb. The risk of lower extremity amputation is 15 to 46 times higher in diabetics than in persons who do not have diabetes mellitus. Physically, an amputation may change ability to carry out the tasks for a person that he was previously capable of doing. It changes the ability to walk and mobilize may also mean that it is more difficult for someone to get out to socialize with others in community or ability to work and maintain a career. This can cause considerable frustration and sadness as there will be a loss in independence. It also creates distortion of body image further bringing self confidence down.¹The global prevalence of Diabetes Mellitus (DM) has been estimated to increase by 7.7% affecting 439 million by 2030 and 642 million by 2040 with current burden of affecting more than 400 million adults in 2014 with a predilection for old people (>65 years). The multifaceted disease has been attributed to sedentary lifestyles, urbanization and ageing The most common complication among 50% of diabetic patients is diabetic foot and attributing to 80% of all non-traumatic lower limb amputations.² In India, NCD contributes to 53% of total mortality, and around 2% of it is contributed by diabetes mellitus.³Most of the diabetic foot related problems are preventable if appropriate measures are taken.In India, the prevalence of diabetic foot ulcers in the clinic population is 3.6%.⁴ The practice of foot care measures such as daily foot washing and drying, daily foot examination, proper nail care, and foot wear are important with regard to prevention and early detection of the expected complications. Patients with poor knowledge and practices about diabetic foot care have a higher incidence of diabetic foot complications.⁵ It is important for the nurse to acknowledge the patient’s concerns and to involve the patient as much as possible in the plan of care. If the patient disagrees with certain aspects of the nursing or medical care related to diabetes, the nurse must communicate this to other members of the health care team and, where appropriate, make changes in the plan to meet the patient’s needs. The nurse and other health care providers need to pay particular attention to patients who are successful in managing self-care, assess their self-care management skills, and encourage them to continue their self-care management if correct and appropriate. And also, from the above mentioned studies, investigator found that there is a need to strengthen the knowledge, expressed practice and attitude regarding diabetic foot care in patient with diabetes which will help them to improve their knowledge and practices in their disease management.

PROBLEM STATEMENT:

“A study to assess the knowledge, expressed practice and attitude regarding diabetic foot care in patient with diabetes at MDM hospital Jodhpur”

OBJECTIVES:

1. To assess the knowledge score of patients with diabetes regarding diabetic foot care.

2. To assess the expressed practice score of patients with diabetes regarding diabetic foot care.

3. To assess the attitude score of patients with diabetes regarding diabetic foot care.

4. To find out association between knowledge score of patients with diabetes regarding diabetic foot care with their selected socio-demographic variable.

5. To find out association between expressed practice score of patients with diabetes regarding diabetic foot care with their selected socio-demographic variable.

6. To find out association between attitude score of patients with diabetes regarding diabetic foot care with their selected socio-demographic variable.

7. To find out association between knowledge score and expressed practice score of patients with diabetes regarding diabetic foot care.

8. To find out association between knowledge score and attitude score of patients with diabetes regarding diabetic foot care.

9. To find out association between expressed practice score and attitude score of patients with diabetes regarding diabetic foot care.

10. To find out correlation between knowledge score, expressed practice score, and attitude score of patients with diabetes regarding diabetic foot care.

Hypothesis / Hypotheses:

^H0 ^{= There will be less knowledge of diabetic foot care in patient with diabetes.}

^H1 ^{= He may have some more knowledge about diabetic foot care.}

METHODOLOGY:

Research approach and design:

Quantitative research approach was used in this study and descriptive research design was adopted for the present study.

Setting of the study:

The study is conducted at Mathura Das Mathur Hospital, Jodhpur

Population:

Target population:

Target population is patients with Diabetes Mellitus.

Accessible population:

Accessible population is patients with Diabetes Mellitus admitted in MDM Hospital, Jodhpur.

Samples:

Diabetes mellitus patient who were admitted in MDM Hospital, Jodhpur.

Sample size:

Sample size was 100 patients with diabetes mellitus who were admitted in MDM Hospital, Jodhpur.

Sampling technique:

Non – probability convenient sampling technique was used by the researcher in this study.

Inclusion Criteria:

Diabetic patient who are admitted in ward of MDM hospital.

Exclusion Criteria:

Diabetic patient who came to OPD treatment

Diabetic patients who came for follow up case.

Patients diagnosed with diabetes mellitus, who can’t read Hindi or English.

Description of the Tools:

The instruments used in this study consisted of four sections.

Section A:-It compromised of socio-demographic variables of patient such as age, gender, educational qualification, occupation, religion, area of living, duration of illness diagnosed, type of diabetes, presence of diabetic complications, attended any educational programme regarding diabetic foot care.

Section B: - It consists of self-structured knowledge questionnaire regarding diabetic foot care.

Section C: -It consists of expressed practice checklist for diabetic foot care.

Section D: -It consists of attitude checklist for diabetic foot care (Likert scale).

Data Collection Procedure:

Written permission was obtained from ethical committee of Medical College, Jodhpur prior to data collection. The samples were patients with diabetes mellitus who were admitted in MDM Hospital, Jodhpur. .The purpose of the study was explained and obtained informed consent was obtained from patients.

Plan For Data Analysis:

The data obtained was analyzed using both descriptive and inferential statistics.

Frequency and percentage distribution was used to determine the socio-demographic variables. Mean, median, mode, and standard deviation was evaluated to assess the knowledge, expressed practice and attitude score regarding diabetic foot care among patients diagnosed with diabetes mellitus.

Chi-square tests was used in finding association between knowledge, expressed practice and attitude regarding diabetic foot care among patients diagnosed with diabetes mellitus and their selected demographical variables.

RESULTS:

The demographic characteristics of the respondents revealed that

Majority (51%) of participants was from the age group of >60years.

Majority of the respondents (63%) were male.

Majority of the respondents (29%) of the samples were graduated

Distribution of respondents according to occupation shows that majority percentages 77% of the samples were others

Majority of the respondents (70%) of the samples were hindu

Majority of the respondents 61% of the samples were belongs to rural area.

Distribution of respondents according to duration of illness diagnosed revealed that 34 % of the samples were diagnosed in 2 years

Majority of the respondents 89 % of the samples were type – II diabetes mellitus patients

Distribution of respondents according to presence of diabetic complications shows that majority percentages 74% of the samples were having no complications

Majority of the participants 83 % were not attended any educational programmed related to diabetes.

Assessment of knowledge score of patients with diabetes mellitus regarding diabetic foot care

Fig.1 Bar diagram showing Frequency and percentage distribution of level of knowledge score of the patients with diabetes mellitus

Table 1 Mean and Standard deviation score of knowledge regarding diabetic foot care in patients with diabetes mellitus

Level of Knowledge	Frequency	Percentage Distribution	mean	SD
Poor	49	49 %	5.73	2.13
Moderate	24	24 %
Adequate	27	27 %

Level of Knowledge	Frequency	Percentage Distribution	Mean	Median	Mode	SD	Min Score	Max Score
Poor	49	49 %	3.86	4	4	0.97	02	5
Moderate	24	24 %	6.46	6	6	0.50	6	7
Adequate	27	27 %	8.48	8	8	0.63	8	10

Level Of Practice	Frequency	Percentage Distribution	MeanScore	SD
Poor practice	39	39 %	6.17	1.98
Average practice	33	33 %
Good practice	28	28 %

Level of Practice	Frequency	Percentage Distribution	Mean	Median	Mode	SD	Min Score	Max Score
Poor practice	39	39 %	4.15	4	5	0.89	2	5
Average practice	33	33 %	6.42	6	6	0.49	6	7
Good practice	28	28 %	8.68	9	8	0.71	8	10

Level Of Attitude	Frequency	Percentage Distribution	Mean Score	Sd
Unfavorable attitude	23	23 %	27.61	11.95
Neutral attitude	31	31 %
Favorable attitude	46	46 %

Level of Attitude	Frequency	Percentage Distribution	Mean	Median	Mode	SD	Min Score	Max Score
Unfavorable attitude	23	23 %	11.70	12	14	2.61	06	15
Neutral attitude	31	31 %	22.39	21	20	4.05	16	30
Favorable attitude	46	46 %	39.09	40	42	4.41	31	47

Level of Knowledge	Poor Knowledge	Moderate Knowledge	Adequate Knowledge	Chi - Square	D.F.	P Value
Level of Practice				75.51	4	0*
Poor Practice	33	5	1
Average Practice	15	15	3
Good Practice	1	4	23

Level of Practice	Poor Practice	Moderate Practice	Adequate Practice	Chi - Square	D.F.	P Value
Level Of Attitude				34.59	4	0.000001*
Unfavorable Attitude	19	2	2
Neutral Attitude	14	12	5
Favorable Attitude	6	19	21

Sr.No.	Aspects	Mean	Mean Percentage	Median	Standard Deviation	Correlation
1.	Knowledge	5.73	57.3 %	6	2.13	0.97*
2.	Expressed Practice	6.17	61.7 %	6	1.98