Effectiveness of an Educational Strategy Focused on Foot Care in Patients with Diabetes Mellitus in Tijuana, Mexico

Research Article

J Fam Med. 2019; 6(1): 1156.

Effectiveness of an Educational Strategy Focused on Foot Care in Patients with Diabetes Mellitus in Tijuana, Mexico

Verdugo-Salazar JPN¹, Coria-Chavez K¹, Ruiz- Gonzalez G¹, Bermudez-Villalpando VI¹, Lopez- Gomez RJ² and Ramirez-Leyva DH³*

¹Department of Family Medicine, Family Medicine Unit #27 (IMSS), Baja California Delegation, Mexico

²Department of General Medicine, Autonomous University of Sinaloa (UAS), Sinaloa, Mexico

³Department of Family Medicine, Family Medicine Unit #37 (IMSS), Sinaloa Delegation, Mexico

*Corresponding author: Ramirez-Leyva Diego Hazael, Department of Family Medicine, Family Medicine Unit #37 (IMSS), Sinaloa Delegation, México

Received: November 24, 2018; Accepted: January 21, 2019; Published: January 28, 2019


Background: Diabetic Neuropathy (DN) is a microvascular complication manifested by unfavorable evolution of Diabetes Mellitus (DM), which, when not receiving adequate treatment, is invalidating. Education on this topic has shown benefits in the development of the disease and delay its appearance.

Aim: The purpose of this study is to determine the effectiveness of an educational intervention on the knowledge of foot care in patients with diabetes mellitus.

Design and Setting: Uncontrolled clinical trial, educational intervention before and after.

Methods: In 77 patients in the Family Medicine Unit #27, Tijuana, Baja California, an educational intervention was carried out. Six educational sessions were given with groups of 10 individuals, each educational intervention lasted 20-30 minutes; relevant topics for foot care in patients with diabetes mellitus were addressed. Two measurements of knowledge about foot care were made, one before and the other after the intervention; the Foot Care Confidence Scale (FCCS) in Spanish was used to assess knowledge. To determine differences between the knowledge before and after, the Wilcoxon test was used for statistical significance with 95% interval confidence (p<0.05).

Results: We analyzed 77 participants who attended all the educational sessions, there was no loss of patients. An increase in knowledge about foot care after receiving the intervention was found (Wilcoxon Z: -6.905, p ?0.05).

Conclusion: The educational strategy was effective to increase the knowledge of foot care. It is recommended to perform similar interventions in larger groups and to promote lines of research focused on preventing peripheral complications of Diabetes Mellitus.

Keywords: Diabetic Foot; Educational Strategy; Diabetes Mellitus


Diabetic neuropathy is a group of heterogeneous disorders, usually produced by high glucose levels sustained for a long period of time, affecting the distal nerve endings mainly in the lower limbs. One of the most frequent complications is diabetic foot, a disabling disorder that results in devastating consequences for the integrity of the patient with Diabetes Mellitus [1]. A multidisciplinary approach is recommended for the care of this type of foot, which is described as a high risk foot, changing the follow-up that should be given to the patient with DM. An annual evaluation must be carried out by physicians of first contact in feet without risk and, if the foot has a high risk, it should be followed up every 3-6 months. It has been shown that in high-risk patients, education reduces the incidence of ulcers and amputations, reducing the evolution of complications of diabetic neuropathy [2].

In 2016, it was reported that of the total of patients with a previous diagnosis of diabetes, 41.2% had symptoms of diabetic neuropathy and it is estimated that 46.4% with diagnosis of neuropathy are not aware of preventive measures. In recent years it has been reported that the most used preventive measures have been foot care [3]. There are sociocultural barriers that affect patients in the modification of lifestyle and techniques to perform foot care. The most common barriers described are lack of medical knowledge, administrative limitations, logistical barriers and lack of communication [4]. Since the beginning of the 21st century, a consensus was established in which foot care requires multidisciplinary management at the first and second level of care, first contact physicians and nurses must be educated about care of the foot and how to recognize early lesions of the diabetic foot, in order to reduce the incidence of disease and sequelae in patients with established diagnosis [5].

One reason why it has been shown that educational interventions work in patients with DM is by empowerment, which is the process where patients have the knowledge, skills, attitudes and self-awareness to be able to influence behavior. Similarly, patients can influence other patients with DM, to form a trend that is transmitted between each patient [6]. Based on the above, the main objective of this research is to determine the effectiveness of an educational intervention on the knowledge of foot care in patients with diabetes mellitus.

Materials and Methods

An educational intervention study before and after was carried out in the Family Medicine Unit #27, of the Instituto Mexicano del Seguro Social (IMSS), located in Tijuana, Mexico; in patients which were selected by a consecutive sampling techniques; that met the following inclusion criteria: age between 20-70 years, with at least three years of evolution with DM, any sex, that accepted and signed an informed consent; patients with a history of diabetic foot or diabet IMSS were not included and eliminated those who did not complete the educational intervention or those with incomplete information.

The following data were obtained directly from the patients or medical records: age, sex, marital status, scholarship, level of self-care knowledge of the feet. The procedure for the data collection was as follows: age was calculated in years according to the year of birth, sex was determined by the phenotype characteristics of each individual, marital status was expressed by each patient, scholarship was determined by asking directly to patients, level of self-care knowledge of the feet was evaluated according to the Foot Care Confidence Scale (FCCS) in Spanish, which has an internal consistency (Cronbach's alpha) of 0.782, this instrument has 12 questions on Likert scale, a high score means a better knowledge of foot care (Figure 1). The educational intervention was divided into six sessions (Table 1), with groups of 10 individuals; each session lasted 20-30 minutes once per week.