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\def\RunningAuthor{Cecyli C and Thamupriyadharshini}
\firstPage{3922}
\articleType{Original Article}
\receivedDate{06 Jan 2020}
\acceptedDate{09 Mar 2020}
\revisedDate{10 Feb 2020}
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\title{A Study To Assess The Knowledge And Practice of Foot Care Among Diabetic Clients Attending Diabetic OPD}
\author{Cecyli~C\textsuperscript{*}, 
            Thamupriyadharshini~\\[5pt]{Department of Medical and Surgical Nursing, Saveetha College of Nursing, SIMATS, Chennai, Tamil Nadu, India}}

\begin{abstract}
Diabetic foot is one of the most common and distressing complication of diabetes resulting to major physical limitation, psychological and fiscal significances for the patient and their families. Great information and skill on regards to diabetic foot care will lessen the danger of diabetic foot difficulties and that will diminish the odds of removal of the limb. A descriptive study was adopted for assessing the level of knowledge and practice of Foot care among diabetic clients. A total of100 diabetic clients were selected using purposive sampling technique. Data were gathered utilizing self-structured questionnaire by a structured interview method. The outcomes portray that majority of the diabetic clients, 61\% had inadequate knowledge, 28\% had moderate knowledge and only 11\% of the diabetic clients had average knowledge. The examination also uncovers that 23\% of the diabetic clients had good practice and 77\% had poor practice. The mean knowledge and practice score were 5.82 \ensuremath{\pm} 2.53\& 6.97\ensuremath{\pm}1.18 respectively. There is the strong connection (r= 0.698, p=0.0001) between Knowledge and Practice. There is statistically significant association of demographic variables noted with the knowledge and practice of foot care between age, Gender, Educational Status, Occupation, Duration of Diabetes, Current Diabetes Treatment, Presence of Co morbid (P values {\textless}0.001).
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Diabetic clients,\newline Knowledge,\newline Practice,\newline Foot Care
\end{keywords}
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\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Cecyli~C~\\ Phone:\ 8754513626~\\  Email:\ cecylichandrasekaran1407@gmail.com 
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\section{Introduction}
India is known as Diabetes capital of the world. Diabetes Mellitus is a metabolic disorder because of either insulin resistance and as well as relative or total insulin insufficiency. The estimate of 41 million individuals with diabetes in India influencing 10-16 \% of urban population and 5.33-6.36 \% of country population is required to ascend to 66 million by 2025 \unskip~\citep{774169:18409374,774169:18409372}.

According to International Diabetes Federation (IDF), In 2019, Approximately 463 million Adults (20-79 years) were living with diabetes, by 2045 this will ascend to 700 million. 1 of every 2 (232 million) individuals with diabetes were undiscovered. Diabetes caused 4.2 million deaths. 374 million individuals are at expanded danger of creating type 2 diabetes\unskip~\citep{774169:18409370}.

Diabetes and its complexities are turning out to be regular worldwide general wellbeing challenges ascribing to a transcendent reason for disease and passing\unskip~\citep{774169:18409368}. There will be more than 642 million individuals with diabetes comprehensively by 2040. In 2018, the International Diabetes Federation (IDF) detailed that around 4 out of 5 individuals aged 20{\textendash}79 live with diabetes in low and middle income nations representing 5{\textendash}22\% of worldwide pervasiveness\unskip~\citep{774169:18409375}.

As indicated by insights taken from International Diabetes Federation (IDF), the prevalence of Diabetes was seen as over 8\%, influencing around 382 million adults in the year 2013. The future will be increasingly hazardous and it is assessed that continuously 2035 the predominance will be about 8.8\% among adults and will influence around 592 million adults on the planet \unskip~\citep{774169:18409373}.

Diabetic foot (DF) is the most well-known inconvenience. It is extreme and exorbitant to oversee. Amputation is 10{\textendash}20 times progressively regular in individuals with diabetes. It is evaluated that at regular intervals, a lower appendage or part of a lower appendage is lost as a result of diabetes \unskip~\citep{774169:18409377}.

One of the significant complications related with DM is the diabetic foot (DF) syndrome. This complication nearly influences half of patients and records for almost 80\% of all nontraumatic removals of the lower appendage\unskip~\citep{774169:18409369}. The disease expresses to almost 35\% of all hospital admissions in diabetic specific centers\unskip~\citep{774169:18409371}.

Alongside the rising predominance of diabetes increment in the complications are expected which will additionally trouble our medical services. One of the significant inconveniences among diabetics is diabetic ulcer which prompts removal of affected foot\unskip~\citep{774169:18409376}.

The diabetic foot is additionally entangled by some undesired and wrong practices, for example, Socio- cultural myths of strolling shoeless and so on. Some of the time, wrong utilization of footwear and lack of awareness with respect to foot care during diabetes mellitus additionally make the foot intricacy extreme \unskip~\citep{774169:18409424}.

The commonness of foot issues is higher in low financial gatherings because of poor glycemic control and improper consideration of foot. The immediate and round about cost engaged with the treatment of foot issues in patients with diabetes is gigantic. 

There is a critical need to execute preventive measures to lessen the cost weight of the patients and the general public. The American Diabetes Association prescribes that individuals with diabetes should have a far-reaching foot assessment once per year \unskip~\citep{774169:18409422}.

Diabetic foot ulcers are one of its generally serious and expensive inconveniences and one of the most widely recognized reasons for hospitalization of diabetic patients. Hence, we conduct the study to evaluate the knowledge and practice of foot care among diabetes clients who are attending diabetic outpatient department.
    
\section{Materials and Methods}
For the present study, a quantitative approach with descriptive research design was used. The study was conducted in Saveetha Medical College and Hospital, Chennai. Which is 1200 bedded Multi Specialty hospital, approximately 100 diabetic patients are attending the diabetic outpatient department (OPD) every day. 

A study was conducted after obtaining ethical clearance from the Institutional Ethical Committee of Saveetha Institute of Medical and Technical Sciences. A formal permission was obtained from the Medical Dean at Saveetha Medical College and Hospital. 

The data were collected from 100 diabetic mellitus patients who met the inclusion criteria by using a purposive sampling technique. Self-structured questionnaire was developed by the investigator consisting of 3 sections, demographic variables along with clinical variables, knowledge questionnaire and practice questionnaire regarding foot care. 

The written consent was obtained from each participant after explaining the study in detail and the demographic data was collected. The data were collected through structured interview method and data was analyzed with descriptive and inferential statistics.


\begin{table*}[!htbp]
\caption{\boldmath {Level of Practice of Foot care among diabetic clients attending Diabetic OPD } }
\label{tw-712e92235769}
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\tbltoprule \rowcolor{kwdboxcolor}S.No & Level of Practice & N & \%\\
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1. &
  Good &
  23 &
  23\\
2. &
  Poor &
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\caption{\boldmath {Level of Knowledge on Foot care among diabetic clients attending Diabetic OPD}}
\label{f-ebdf9a0cc0e2}
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\section{Results and Discussion}
The results of the present examination uncovered that with respect to sex 63 \% of clients has a place with male, 34\% were in the age gathering of 56-65 years. 84\% of them were hitched. Regarding the religion 71\% were Hindu and 53 \% were rancher. With respect to educational qualification, 35\% of the clients have a place with primary education. As for length of diabetes, 58\% of clients has been with diabetic mellitus for past 5-10 years. 56\% of the clients were under oral hypoglycemic treatment. 44\% of the clients have co-morbid. 32\% of the clients were smoker.

The present investigation results depict that,61\% of the diabetic clients had inadequate knowledge, 28\% had moderate knowledge and 11\% of the diabetic clients had average knowledge (Table~\ref{tw-712e92235769})

The present investigation reveals that 23\% of the diabetic clients had good practice and 77\% had poor practice. (Figure~\ref{f-ebdf9a0cc0e2}) The mean knowledge \& practice score were 5.82 \ensuremath{\pm} 2.53 \& 6.97\ensuremath{\pm}1.18 respectively. 

The present examination bolsters the cross-sectional investigation coordinated to evaluate awareness and practice of diabetic foot self-care among 488 patients of type-2 diabetes going to the diabetic clinics in primary healthcare centres under Dubai Health Authority. 

The general familiarity with foot self-care was seen as poor in 47\%, normal in 26\% and great in just 27\% of the members, the general act of foot self-care was seen as poor in 46\%, normal in 26\% and great in just 28\% of the members. 

Hence, the members had a general poor Awareness and poor act of foot self-care\unskip~\citep{774169:18409423}. 

Thus, a cross sectional investigation directed to evaluate the degree of knowledge and practice of foot care among 157 diabetic clients. The after effects of the investigation uncovered that 58\% had poor foot care knowledge while 61.8\% had poor diabetic foot care practice when contrasted with the median score. Instruction in regards to foot care procedures ought to be underscored and engaged inside the diabetic population\unskip~\citep{774169:18409425}. 

Similarly an cross-sectional study was conducted to evaluate associated risk factors, awareness and practice level of diabetic foot self-care among type II diabetic patients outpatient departments of Akbar khan Niazi teaching hospital and PIMS hospital. The study demonstrated that a more prominent extent (41.3\%) of diabetic patients had a poor knowledge on diabetic foot care, 23.5\% had average knowledge and just 35.2\% had good knowledge on diabetic foot self-care. 

Essentially, the diabetic foot self-care practice level was additionally discovered poor in generally (39.8\%) of the members, 24.0\% had average practice level and 36.2\% patients had well diabetic foot self-care practice \unskip~\citep{774169:18409421}. 

The present investigation demonstrates that there is a positive relationship (r=0.698, p=0.0001) noted between knowledge and practice. The examination finding likewise supported by study discoveries of a descriptive study conducted to assess the knowledge and practice on with respect to foot care among diabetes patients. 

The assessment suggested that there is an ideal connection amongst knowledge and practice on with respect to foot care among diabetic patients Correlation coefficient (r) = 0.2842.,95\% certainty interval \unskip~\citep{774169:18410037}. 

The findings of the study supports the findings of cross-sectional study to explore knowledge, attitudes and practice (KAP) among foot ulcer patients with and without diabetes who sought treatment at Georgetown Hospital in Guyana. There was noteworthy connection between patients diabetic status and their knowledge (r=0.2, P\ensuremath{\leq }0.05) and practice (r=\ensuremath{-}0.3, P\ensuremath{\leq }0.01) scores \unskip~\citep{774169:18410036}. 

The present investigation results display that association of demographic variables with the knowledge and practice of foot care was age, Gender, Educational Status, Occupation, Duration of Diabetes, Current Diabetes Treatment, Presence of Comorbid was found to be associated with both diabetic foot care knowledge \& practice (P values {\textless}0.001). 

This investigation additionally supports a study focused to assess the Knowledge and practice of foot care amongst diabetic patients attending a tertiary care hospital of Kolkata, India. 

The results uncovered that Gender, residence, education, occupation, income, family history of diabetes, duration, regular use of medication was found to be associated with both knowledge \& practice (P values {\textless}0.05) \unskip~\citep{774169:18410035}.
    
\section{Conclusions}
The Present investigation surmises, that there is inadequate knowledge and poor practice of diabetic foot care among the patients of diabetic mellitus. This can lead to progression of diabetic foot to Diabetic Foot Ulcer and lately end to amputation. This can be prevented by giving legitimate training about the knowledge and practice of foot care for the patients on consideration of their feet. This may lessen the grimness and loss of appendage in diabetic patients and that in its turn can spare our assets.

\textbf{Conflict of Interest}

None.

\textbf{Funding Support}

None.
    

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