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 two 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 (TUQ). 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; 34/39 (87%) completed the first videoconference, and 29/39 (74%) completed the second and third videoconferences. Of the 39 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 TUQ score of 6.24 (SD 0.98) on a 7-point scale. Diabetes knowledge increased by a mean of 15.82 points of 100 (SD 16.69; P<.001) from baseline to 3 months. The values for Summary of Diabetes Self-Care Activities demonstrated better self-care, with participants performing foot care on average 1.74 more days per week (SD 2.04; P<.001), adhering to healthy eating habits on average 1.57 more days per week (SD 2.12; P<.001), and being physically active on average 1.24 more days per week (SD 2.21; P=.005). Participants also reported an improvement in the frequency of self-foot examinations and general foot care behaviors. The mean scores for foot care increased by a mean of 7.65 points (scale of 7 to 35) from baseline to 3 months post-intervention (SD 7.04; 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 that are precursors to preventing debilitating foot complications.
CLINICALTRIAL