Effect of Educational Programs on Foot Care Knowledge and Practices among Diabetes Patients in Asia: A Systematic Review

Rosehaidza Mat Zam; Siti Khuzaimah Ahmad Sharoni; Septa Katmawanti

doi:10.21834/e-bpj.v11i37.7943

Authors

Rosehaidza Mat Zam Centre for Nursing Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Selangor Branch, Puncak Alam Campus, Puncak Alam, Selangor, Malaysia. https://orcid.org/0009-0002-1249-9462
Siti Khuzaimah Ahmad Sharoni Centre for Nursing Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Selangor Branch, Puncak Alam Campus, Puncak Alam, Selangor, Malaysia
Septa Katmawanti Public Health Department, Faculty of Sport Science, Universitas Negeri Malang, Malang, East Java, Indonesia

DOI:

https://doi.org/10.21834/e-bpj.v11i37.7943

Keywords:

Diabetes Mellitus, Diabetes Foot Care, Educational Intervention, Foot Care Practice

Abstract

Diabetic foot complications are a public concern, a leading cause of morbidity, disability, and reduced quality of life. Promoting effective foot care through education for enhancing functional independence, well-being, and quality of life. This review, guided by the PRISMA 2020 guidelines, included studies from January 2015 to March 2025, comprising three randomized controlled trials and 13 quasi-experimental studies conducted in Asian countries. The results revealed that interventions varied, including face-to-face education, printed and multimedia materials, mobile health applications, and community-based programs. Findings indicate improvements in knowledge and foot care practices, and that educational interventions are effective in strengthening these.

References

Abdul Hadi, A., Azmi, N. H., Md Aris, M. A., Che Ahmad, A., & Nasreen, H. E. (2019). Prevalence and associated factors of diabetic foot at risk among type 2 Diabetes mellitus patients attending primary health clinics in Kuantan. The 2019 National Diabetes Registry Report. Institute for Public Health, Ministry of Health Malaysia

Abdullah et al. (2021). The Effects of Diabetic Footcare Programme Towards Quality of Life Among Type II Diabetes Mellitus Patients in UKM Medical Centre (UKMMC). Malaysian Journal of Medicine and Health Sciences,17(4):181-188

Ahmad Sharoni, S., Rahman, H., Minhat, H., Sazlina, S.-G., & Azman Ong, M. H. (2018). The effects of self-efficacy enhancing program on foot self-care behaviour of older adults with diabetes: A randomised controlled trial in elderly care facility, Peninsular Malaysia. PLoS One, 13, e0192417. https://doi.org/10.1371/journal.pone.0192417 DOI: https://doi.org/10.1371/journal.pone.0192417

Alshammari, L., O'Halloran, P., McSorley, O., Doherty, J., & Noble, H. (2023). The effectiveness of foot care educational interventions for people living with diabetes mellitus: An umbrella review. J Tissue Viability, 32(3), 406-416. https://doi.org/10.1016/j.jtv.2023.06.001 DOI: https://doi.org/10.1016/j.jtv.2023.06.001

Armstrong, D. G., Swerdlow, M. A., Armstrong, A. A., Conte, M. S., Padula, W. V., & Bus, S. A. (2020). Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res, 13(1), 16. https://doi.org/10.1186/s13047-020-00383-2 DOI: https://doi.org/10.1186/s13047-020-00383-2

Beiranvand, S., Asadizaker, M., Fayazi, S., & Yaralizadeh, M. (2015). Efficacy of an Intervention Based on the Theory of Planned Behavior on Foot Care Performance in Type II Diabetic Patients. Jundishapur Journal of Chronic Disease Care, 5(1). https://doi.org/10.17795/jjcdc-30622 DOI: https://doi.org/10.17795/jjcdc-30622

Dany, F., Dewi, R. M., Tjandrarini, D. H., Pradono, J., Delima, D., Sariadji, K., Handayani, S., & Kusumawardani, N. (2020). Urban-rural distinction of potential determinants for prediabetes in Indonesian population aged ≥15 years: a cross-sectional analysis of Indonesian Basic Health Research 2018 among normoglycemic and prediabetic individuals. BMC public health, 20(1), 1509. https://doi.org/10.1186/s12889-020-09592-7 DOI: https://doi.org/10.1186/s12889-020-09592-7

Fajriyah, N. N., Aktifah, N., & Mugiyanto, E. (2020). Paket Edukasi dan Deteksi Dini Meningkatkan Perilaku Perawatan Kaki Diabetisi di Puskesmas Kabupaten Pekalongan. Gaster, 18(1). https://doi.org/10.30787/gaster.v18i1.402 DOI: https://doi.org/10.30787/gaster.v18i1.402

Frisca, S. (2021). Effectiveness Diabetes Self-Management Education (DSME) to Foot Care Behaviour and Foot Condition in Diabetes Mellitus Patient. KnE Life Sciences, 1069-1077. https://doi.org/10.18502/kls.v6i1.8783 DOI: https://doi.org/10.18502/kls.v6i1.8783

Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. (2023). Lancet, 402(10397), 203-234. https://doi.org/10.1016/s0140-6736(23)01301-6 DOI: https://doi.org/10.1016/S0140-6736(23)01301-6

Hadi Sulistyo, A. A., Sae Sia, W., & Maneewat, K. (2018). The effect of a foot care camp on diabetic foot care knowledge and the behaviours of individuals with diabetes mellitus. J Res Nurs, 23(5), 416-425. https://doi.org/10.1177/1744987118765903 DOI: https://doi.org/10.1177/1744987118765903

Hijazi, H., Abdi, R., Abuhammad, S., Bani-Issa, W., Al-Sharman, A., Saadeh, N., AlMarzooqi, A., Ahmed, F., Hossain, A., Radwan, H., Subu, M., & Alameddine, M. (2025). Assessing the effectiveness of targeted educational interventions on enhancing self-efficacy and foot care practices among diabetic women in Jordan. Frontiers in Public Health, 12, 1502781. https://doi.org/10.3389/fpubh.2024.1502781 DOI: https://doi.org/10.3389/fpubh.2024.1502781

Lazzarini, P. A., Armstrong, D. G., Crews, R. T., Gooday, C., Jarl, G., Kirketerp-Moller, K., Viswanathan, V., & Bus, S. A. (2024). Effectiveness of offloading interventions for people with diabetes-related foot ulcers: A systematic review and meta-analysis. Diabetes Metab Res Rev, 40(3), e3650. https://doi.org/10.1002/dmrr.3650 DOI: https://doi.org/10.1002/dmrr.3650

Lazzarini, P. A., Pacella, R. E., Armstrong, D. G., & van Netten, J. J. (2018). Diabetes-related lower-extremity complications are a leading cause of the global burden of disability. Diabetic Medicine, 35(9), 1297-1299. https://doi.org/https://doi.org/10.1111/dme.13680 DOI: https://doi.org/10.1111/dme.13680

Magliano, D. J., Boyko, E. J., & committee, I. D. F. D. A. t. e. s. (2021). IDF Diabetes Atlas. In Idf diabetes atlas. International Diabetes Federation © International Diabetes Federation, 2021.

Mahdalena, M., & Ningsih, E. S. P. (2016). Effectivity of Foot Care Education Program in Improving Knowledge, Self-Efficacy and Foot Care Behavior of Diabetes Mellitus Patients in Banjarbaru, Indonesia. Kesmas: National Public Health Journal, 11(2). https://doi.org/10.21109/kesmas.v11i2.583 DOI: https://doi.org/10.21109/kesmas.v11i2.583

Nguyen, T. P. L., Edwards, H., Do, T. N. D., & Finlayson, K. (2019). Effectiveness of a theory-based foot care education program (3STEPFUN) in improving foot self-care behaviours and foot risk factors for ulceration in people with type 2 diabetes. Diabetes Res Clin Pract, 152, 29-38. https://doi.org/10.1016/j.diabres.2019.05.003 DOI: https://doi.org/10.1016/j.diabres.2019.05.003

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., . . . Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71 DOI: https://doi.org/10.1136/bmj.n71

Rahaman, H. S., Jyotsna, V. P., Sreenivas, V., Krishnan, A., & Tandon, N. (2018). Effectiveness of a Patient Education Module on Diabetic Foot Care in Outpatient Setting: An Open-label Randomized Controlled Study. Indian J Endocrinol Metab, 22(1), 74-78. https://doi.org/10.4103/ijem.IJEM_148_17 DOI: https://doi.org/10.4103/ijem.IJEM_148_17

Raja, J., Maturana, M., Kayali, S., Khouzam, A., & Efeovbokhan, N. (2023). Diabetic foot ulcer: A comprehensive review of pathophysiology and management modalities. World Journal of Clinical Cases, 11, 1684-1693. https://doi.org/10.12998/wjcc.v11.i8.1684 DOI: https://doi.org/10.12998/wjcc.v11.i8.1684

Reeves, B. C., Deeks, J. J., Higgins, J. P., Shea, B., Tugwell, P., Wells, G. A., & Group, o. b. o. t. C. N.-R. S. o. I. M. (2019). Including non-randomized studies on intervention effects. In Cochrane Handbook for Systematic Reviews of Interventions (pp. 595-620). https://doi.org/https://doi.org/10.1002/9781119536604.ch24 DOI: https://doi.org/10.1002/9781119536604.ch24

Sampson, O., Manaf, R., Ismail, S., Shahar, H., & Udeani, T. (2023). Improving Foot Self-care Practices Through Health Education Intervention Programs Among Diabetic Patients: A Systematic Review. Malaysian Journal of Medicine and Health Sciences, 19, 315-325. https://doi.org/10.47836/mjmhs.19.4.44 DOI: https://doi.org/10.47836/mjmhs.19.4.44

Savari, A., Bashirian, S., Barati, M., & Karimi-Shahanjarini, A. (2023). The Effects of Educational Intervention Based on the Health Belief Model on Improving Foot Self-Care Behaviors in Older Adults. Aging Medicine and Healthcare, 14(1), 21-28. https://doi.org/10.33879/amh.141.2021.09084 DOI: https://doi.org/10.33879/AMH.141.2021.09084

Sharoni, S. K. A., Abdul Rahman, H., Minhat, H. S., Shariff Ghazali, S., & Azman Ong, M. H. (2017). A self-efficacy education programme on foot self-care behaviour among older patients with diabetes in a public long-term care institution, Malaysia: a Quasi-experimental Pilot Study. BMJ Open, 7(6), e014393. https://doi.org/10.1136/bmjopen-2016-014393 DOI: https://doi.org/10.1136/bmjopen-2016-014393

Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B. B., Stein, C., Basit, A., Chan, J. C. N., Mbanya, J. C., Pavkov, M. E., Ramachandaran, A., Wild, S. H., James, S., Herman, W. H., Zhang, P., Bommer, C., Kuo, S., Boyko, E. J., & Magliano, D. J. (2022). IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract, 183, 109119. https://doi.org/10.1016/j.diabres.2021.109119 DOI: https://doi.org/10.1016/j.diabres.2021.109119

Tee, E. S., & Yap, R. W. K. (2017). Type 2 diabetes mellitus in Malaysia: current trends and risk factors. Eur J Clin Nutr, 71(7), 844-849. https://doi.org/10.1038/ejcn.2017.44 DOI: https://doi.org/10.1038/ejcn.2017.44

Toygar, I., Hancerlioglu, S., Utku, T., Simsir, I. Y., & Cetinkalp, S. (2022). Effect of an Educational Intervention Based on Bandura's Theory on Foot Care Self-Efficacy in Diabetes: A Prospective Quasi-Experimental Study. Int J Low Extrem Wounds, 21(4), 414-419. https://doi.org/10.1177/1534734620948327 DOI: https://doi.org/10.1177/1534734620948327

Venkatesh, L., (2022), Assess the effectiveness of foot care nursing interventions on knowledge and preactice of foot care in patients with diabetes mellitus at Rural, Tamilnadu, The Genesis, Vol 9 (3), Jul-Sep. pp.28-34. http://doi.org/10.47211/tg.2022.v09i03.007 DOI: https://doi.org/10.47211/tg.2022.v09i03.007