To what extent do patients with diabetic foot complications recall diabetic foot self-management education?

Background
Foot complications in patients with diabetes are a severe burden. Approx. 25% of all patients with diabetes will develop a foot ulcer during their lifespan. Approx. 80% of all major lower limb amputations are preceded by a foot ulcer (1). Patients following recommended foot care education are less likely to develop foot ulcers than those not following the recommendations. It is crucial for the prevention of foot ulcers that the key messages in the education are heard, understood and remembered by the patients. Previous studies have shown a low degree of consistency (58%) between the podiatrists’ key messages and the instructions patients remember after the consultation (2). Patients’ psychosocial issues can be a barrier to effective communication, and the communicative skills of the podiatrist also influence the education.
Aims:
To compare the instructions that podiatrists communicate to patients, with the instructions remembered by patients immediately after consultations, and explore the level of agreement with different psychosocial issues as possible impacts on the level of agreement.
Methods:
Participants included four podiatrists and 40 patients with diabetes. Data collection includes podiatrists’ notes in the patient record, data from interviews immediately after consultations, background data and the PAID-5 questionnaire (Problem Areas in Diabetes Scale - Five-item Short Form). The main question was: “What information did you get from the podiatrist today regarding the care of your feet?” Chi-square tests were conducted to assess the associations between the level of agreement to the psychosocial issues.
Results:
In the comparison between the podiatrists’ key messages and the patients’ recall of these: 40% full agreement, 37% almost full agreement, 20% almost no agreement and 2% no agreement. There were no significant associations between the level of agreement and the various collected patient demographic or psychosocial data (p=0.10 to p=0.65). In the 22% (n=9) cases with no or almost no agreement, almost everyone recalled key messages about footwear, while recall was missing for other essential parts of foot care such as daily observation of the feet.
Conclusion:
The hypothesized psychosocial barriers for effective education in specific foot self-care, did not seem to influence the variation in agreement in this small sample size. Still 22 % of the patients did not recall important key messages. Future studies should further explore characteristics of the consultation and possibilities of enhancing the recall of the education.
(1) Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217-28.
(2) Yuncken J, Williams CM, Stolwyk RJ, Haines TP. People with diabetes do not learn and recall their diabetes foot education: a cohort study. Endocrine. 2018;62(1):250-8.