Evaluating the effectiveness and acceptability of an animated educational tool for diabetic foot care: A randomized controlled trial and mixed-methods study in patients with active, in-remission and high-risk diabetic foot disease.

Abstract

Introduction: Patients with diabetes have a 2% annual risk of developing a Diabetic Foot Ulcer (DFU). Novel methods of reducing the risk of re-ulceration could reduce the cost of diabetic foot disease.

Materials and methods: Fifty-two patients with active foot disease, a history of prior DFU and/or high-risk feet were included in this study. Patients were randomly assigned 50:50 to be educated conventionally by a podiatrist or to view a bespoke foot self-care educational animation developed by the research team for this exploratory pilot study. A modified Nottingham Assessment of Functional Footcare (NAFF) questionnaire was used to record knowledge of safe foot care behaviors pre- and post-intervention. The primary outcome was change in self-care knowledge score. In parallel, a mixed-methods acceptability study was carried out for the 26 patients in the intervention arm, with quantitative data obtained using a 20-item technology acceptance model. Qualitative data were obtained by face-to-face interviews in the clinic setting and examined using thematic analysis.

Results: While foot self-care knowledge scores were numerically higher in both groups, only the intervention group showed a statistically significant within-group improvement. There was a trend toward a greater magnitude of increase in the knowledge score in favor of the intervention group, but this did not reach statistical significance. Among the 26 patients who completed the technology acceptability study, the majority of responses were in favor of the educational video.

Conclusions: This randomized controlled and mixed-methods study demonstrated positive results in terms of improvements in foot self-care knowledge and acceptability.