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Effect of Diabetes Foot-Care Education on Foot-Care Practices among Adults Living with Diabetes in Nigeria

Abstract

Diabetes mellitus is a major public health concern that may result in complications affecting multiple organs and body systems. Foot complications are among the important complications of diabetes and may include peripheral neuropathy, skin breakdown, infection, ulceration, and, in severe cases, lower-limb amputation. Appropriate foot-care practices can contribute to the prevention, early recognition, and timely management of diabetes-related foot problems. However, some adults living with diabetes may have inadequate knowledge of foot care, irregular foot inspection, inappropriate footwear practices, poor nail care, delayed reporting of foot abnormalities, and limited access to appropriate diabetes education and podiatric or clinical services. Diabetes foot-care education provides an opportunity to improve patients' knowledge and practical skills regarding daily foot inspection, hygiene, footwear, injury prevention, and early healthcare-seeking. Against this background, this study investigates the effect of diabetes foot-care education on foot-care practices among adults living with diabetes in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Self-Efficacy Theory. The Health Belief Model explains how adults' perceptions of their susceptibility to diabetic foot complications, perceived severity, perceived benefits of appropriate foot care, perceived barriers, and cues to action may influence their foot-care practices. Social Cognitive Theory emphasizes observational learning, behavioural reinforcement, social support, and environmental influences in the adoption and maintenance of appropriate self-care behaviours. Self-Efficacy Theory emphasizes individuals' confidence in their ability to perform recommended foot-care behaviours consistently and correctly. Collectively, these theoretical perspectives provide a suitable framework for explaining how diabetes foot-care education may influence foot-care practices among adults living with diabetes in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise adults aged 18 years and above receiving diabetes care in selected hospitals and primary healthcare facilities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, healthcare facilities, diabetes clinics, and eligible adults living with diabetes. Diabetes foot-care education will be assessed using indicators such as exposure to structured foot-care education, frequency of educational sessions, information on daily foot inspection, foot hygiene, nail care, appropriate footwear, prevention of foot injuries, recognition of warning signs, management of minor foot problems, blood glucose management, avoidance of harmful self-treatment, and timely healthcare-seeking. Foot-care practices will be assessed using indicators such as daily foot inspection, washing and drying of the feet, moisturizing practices that avoid inappropriate application between the toes, appropriate nail trimming, use of suitable footwear and socks, avoidance of walking barefoot, checking footwear before use, protection from burns and injuries, prompt reporting of wounds or skin changes, and attendance at recommended clinical appointments. Where appropriate, validated diabetes foot-care knowledge and practice instruments may be used to provide standardized measures. Data will be collected using structured questionnaires, validated foot-care practice assessment tools, patient education records, clinical records, and direct observation where appropriate. Descriptive statistics will be used to summarize participants' characteristics, exposure to foot-care education, and foot-care practices. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of diabetes foot-care education on foot-care practices. Where a quasi-experimental design is adopted, foot-care practice scores before and after the educational intervention may be compared to determine changes associated with the programme. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that diabetes foot-care education has a significant positive effect on foot-care practices among adults living with diabetes in Nigeria. Adults who receive structured and practical foot-care education are expected to demonstrate better daily foot inspection, improved foot hygiene, safer footwear practices, appropriate nail care, greater awareness of foot injury prevention, and earlier reporting of foot abnormalities than adults with limited exposure to foot-care education. Practical demonstrations and repeated education may improve patients' confidence and ability to incorporate appropriate foot-care practices into their daily routines. Education may also encourage individuals to seek professional care promptly when they notice wounds, swelling, colour changes, numbness, pain, or other abnormalities. However, financial constraints, limited access to diabetes education, cultural practices, poor availability of suitable footwear, inadequate healthcare resources, low health literacy, and difficulties maintaining recommended self-care behaviours may affect adherence. The study therefore expects accessible, practical, culturally appropriate, and regularly reinforced diabetes foot-care education to contribute significantly to improved foot-care practices among adults living with diabetes in Nigeria. The study is expected to contribute to the literature on diabetes foot-care education, diabetic foot prevention, foot-care practices, diabetes self-management, chronic disease management, health education, patient self-care, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, primary healthcare centres, diabetes clinics, physicians, nurses, podiatrists, community health workers, diabetes educators, development partners, and policymakers regarding strategies for preventing diabetes-related foot complications. The study will also provide evidence-based recommendations for integrating structured foot-care education into routine diabetes management, strengthening patient education and follow-up, improving access to appropriate footwear and foot-care resources, training healthcare providers in diabetes foot-care counselling, and promoting early reporting and management of foot problems among adults living with diabetes across Nigeria.

Keywords: Diabetes foot-care education, foot-care practices, diabetes mellitus, diabetic foot complications, diabetes self-management, foot ulcer prevention, patient education, chronic disease management, adults, Nigeria, public health.