Study On Foot Self-care Behaviors Among Elderly Type 2 Diabetes Patients At High-risk Of Diabetic Foot And Influencing Factors Thereof

Objective:To investigate the current status of foot self-care behaviors among elderly type 2 diabetes patients at high risk of diabetic foot and analyze the factors that affect their foot self-care behaviors;To explore the relationship between foot self-care behaviors and foot care knowledge,diabetes self-efficacy,social support,and diabetes problems among elderly type 2 diabetes patients at high risk of diabetic foot;Using qualitative research to further explore the foot self-care feelings and existing problems of elderly type 2 diabetes patients at high risk of diabetic foot and to supplement the information that cannot be obtained in quantitative research.Methods:This study employed a research approach that combines quantitative and qualitative research,using convenience sampling to select diabetes patients at high risk of diabetic foot in the endocrine and geriatric departments of a third-level grade-A hospital in Kaifeng City from March 2022 to September 2022 as research subjects.The quantitative research section used a general information survey questionnaire,a foot self-care behaviors scale,a foot care knowledge questionnaire,a diabetes self-efficacy scale,a social support scale,and a diabetes problem questionnaire for investigation.The data were input using Epi Data 3.1.Descriptive analysis,t-tests,one-way ANOVA,Spearman correlation analysis,and multiple linear regression were performed using SPSS 23.0;structural equation modeling was conducted using AMOS 26.0.The qualitative research section employed a semi-structured interview method to conduct in-depth interviews with 13 elderly type 2 diabetes patients at high risk of diabetic foot who scored below 60 points on the foot self-care behaviors scale,analyzing the influencing factors of their foot self-care behaviors.Results:1.The foot self-care behaviors score of the elderly type 2 diabetes patients at high risk of diabetic foot was(46.42±7.57),which is moderately low.Among them,11.80% scored at a high level,50.17% scored at a moderate level,and 38.03% scored at a low level.The foot care knowledge score of the patients was(14.88±3.01),which is moderate.The diabetes self-efficacy score was(83.71±13.22),which is moderate.The social support score was(33.00±9.46),indicating a moderate level of social support.The diabetes problem score was(30.63±12.67),with 64 cases(24.98%)experiencing disease-related stress.2.The results of the correlation analysis showed that foot self-care behaviors in elderly type 2diabetes patients at high risk of diabetic foot was positively correlated with foot care knowledge(r=0.454,p<0.01),diabetes self-efficacy(r=0.563,p<0.01),and social support(r=0.470,p<0.01),while negatively correlated with diabetes problems(r=-0.427,p<0.01).3.Using the total score of foot self-care behaviors as the dependent variable and the statistically significant factors from the one-way ANOVA results as independent variables,multiple linear regression analysis was conducted.The results showed that educational level,monthly personal income,glycated hemoglobin,foot care knowledge,diabetes self-efficacy,social support,and diabetes problems were included in the final regression equation,explaining a total of 42.10% of the variation in foot self-care behaviors for patients.4.The results of the AMOS structural model showed that social support and diabetes self-efficacy have partial mediating effects between foot care knowledge and foot self-care behaviors,with the mediating effect accounting for 55.15% of the total effect.Social support and diabetes self-efficacy have partial mediating effect between diabetes problems and foot self-care behaviors,with the mediating effect accounting for 81.60% of the total effect.5.Qualitative research findings: A total of 5 themes and 13 subthemes were identified.(1)Lack of awareness of diabetes high-risk foot(underestimation of the severity of the condition,lack of awareness of high-risk foot symptoms,and lack of attention to the feet).(2)Inadequate self-care motivation(difficulties in maintaining foot self-care behaviors,and inadequate diet management).(3)Emotional and cognitive changes(worry and guilt,hopelessness leading to negative attitudes towards treatment,and positive coping strategies).(4)Lack of resource support(limited foot care health education,economic pressure,and limited family support for disease control).(5)Meeting the foot care needs(access to professional guidance and emotional support).Conclusion:(1)Foot self-care behaviors among elderly type 2 diabetes patients at high risk of diabetic foot are at a moderate to low level.(2)Foot self-care behaviors among elderly type 2 diabetes patients at high risk of diabetic foot are positively correlated with foot care knowledge,diabetes self-efficacy,and social support,and negatively correlated with diabetes problems.This indicates that higher scores in foot care knowledge,diabetes selfefficacy,and social support are associated with better foot self-care behaviors,while higher scores in diabetes problems are associated with poorer foot self-care behaviors.(3)Educational level,personal monthly income,glycated hemoglobin,foot care knowledge,diabetes self-efficacy,social support,and diabetes problems are the main factors affecting foot self-care behaviors in elderly type 2 diabetes patients at high risk of diabetic foot.(4)Knowledge about foot care can directly influence self-care behaviors related to the feet,and also indirectly impact these behaviors through self-efficacy and social support for diabetes management.Diabetes-related issues primarily affect self-care behaviors related to the feet through self-efficacy and social support.(5)Foot self-care experiences among elderly type 2 diabetes patients at high risk of diabetic foot included a lack of awareness of diabetes high-risk foot,inadequate self-care motivation,emotional and cognitive changes,and.lack of resource support,and meeting the foot care needs.