Effectiveness of self-learning module on the knowledge and practices regarding foot care among type II diabetes patients in East Delhi, India

Reeta Devi, Bimla Kapoor, Mongjam Meghachandra Singh


Background: Promoting self-care practices forms the cornerstone of care among patients of type II diabetes specially foot care which is widely neglected by the patients. The present study explored the effectiveness of a self-learning module (SLM) on the knowledge and practices regarding foot care among type II diabetic patients (T2DM).

Methods: An earlier house to house survey identified 340 type II diabetic patients in a residential area of East Delhi. The patients were divided into four groups consecutively each having 85 T2DM patients. The groups were randomized into intervention group with SLM and another as control. Pre and post-test evaluation (after three months) was done using pre-tested interview schedule on knowledge and practices regarding foot care.   Chi-square, Mc Nemar’s test, ‘t’ test (paired and unpaired) were used for pre-post comparison of knowledge and practices. ‘p’ less than 0.05 was considered significant.

Results: The age of the study subjects ranged from 20 to 80 years with similarity between intervention (SLM) and control groups in terms of distribution of various socio-economic and demographic variables (p>0.05). SLM was significantly effective than control group in increasing knowledge on aspects of effect of diabetes on foot (p<0.05), foot care and its steps (p<0.05). The mean pre-test score on foot care procedure were 9.55±3.33 in SLM and 9.04±3.55 in control groups. The mean score increased to 36.9±4.35 in SLM (p<0.001) and 9.37±3.84 (p=0.48) in control groups in post-test.

Conclusions: SLM was effective in increasing knowledge and practices regarding foot care among type II diabetic patients in East Delhi.


Knowledge, Practices, Foot care, Diabetes

Full Text:



American Diabetes Association. Standards of Medical Care in Diabetes-2008. Diabetes Care. 2008;31:s12-54.

Bouiton AJ, Malik RA. Diabetic Neuropathy. Med Clin North Am. 1998;82:909-29.

Sicree R, Shaw JE, Zimmet PZ. The global burden of diabetes. In: Gan D, ed. Diabetes Atlas, 2nd ed. Brussels: International Diabetes Federation, 2003: 15-71.

Roglic G, King H. Diabetes mellitus in Asia. Hong Kong Med J. 2000;6:10-1.

Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK, et al. High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia. 2001;44:1094-101.

Varma NPS, Mehta SP, Madhu SV, Mather HM, Keen H. Prevalence of known diabetes mellitus in an urban Indian environment: the Darya Ganji diabetes survey. Br Med J. 1986;293:423.

Misra A, Pandey RM, Devi JR, Sharma R, Vikram NK, Khanna N. High prevalence of diabetes, obesity and dyslipidaemia in urban slum population in northern India. Int J Obes. 2001;25:1722-9.

Prabhakaran D, Shah P, Chaturvedi V, Ramakrishnan L, Manhapra A, Reddy KS. Cardiovascular risk factor prevalence among men in a large industry of northern India. Natl Med J India. 2005;18:59-65.

Ahmad A, Ahmad MT. Assessment of knowledge, attitude and practice among diabetic patients attending a health care facility in North India. Indian Journal of Basic and Applied Medical Research. 2015:4(3):501-509.

Jackson IL, Adibe MO, Okonta MJ, Ukwe CV. Knowledge of self-care among type 2 diabetes patients in two states of Nigeria. Pharm Pract (Granada). 2014;12(3):404.

Al-Maskari F, El-Sadig M, Al-Kaabi JM, Afandi B, Nagelkerke N, Yeatts KB. Knowledge, attitude and practices of diabetic patients in the United Arab Emirates. PLoS One. 2013;8(1):e52857.

Kheir N, Greer W, Yousif A, Al G H, Al OR. Knowledge, attitude and practices of Qatari patients with type 2 diabetes mellitus. Int J Phar Pract. 2011;19(3):185-91.

Majra P, Acharya D. Awareness regarding self care among diabetics in rural India. Middle East Journal of Family Medicine. 2009;7(6):11-4.

Jain PK. Knowledge and attitude of diabetic patients regarding diabetic diet, exercise and foot care. International Journal of Nursing Education. 2012;4:141-5.

Desalu OO, Salawu FK, Jimoh AK, Adekoya AO, Busari OA, Olokoba AB. Diabetic foot care: self reported knowledge and practice among patients attending three tertiary care hospitals in Nigeria. Ghana Med J. 2011;45:60-5.

American Diabetes Association. National standards for diabetes self-management education and support. Diabetes Care.2014;37:S144-S153.

Hoque MA, Islam MDS, Khan MDAM, Ahasan H. Knowledge of diabetic complications in a diabetic population. J Medicine. 2009;10:90-3.

Upadhyay DK, Mohamed MI, Alurkar VM, Mishra P, Palaian S. Evaluation of knowledge, attitude and practice of newly diagnosed diabetes patients- a base line study from Nepal. International Journal of Pharmacy Teaching and Practices. 2012;3:245-52.

Khapre MP, Mudey A, Goyal RC, Wagh V. Low Awareness of Diabetes Affecting the Clinical Outcome of Patients A Cross-Sectional Study Conducted in Rural Tertiary Care Hospital. Int J Bio Med Res. 2011;2:627 -30.

Kaur K, Singh MM, Kumar, Walia I. Knowledge and self-care practices of diabetics in a resettlement colony of Chandigarh. Indian J Med Sci. 1998;52:341-7.

Hamidah H, Santhna LP, Ruth PRD, Suraya AM, Yap WC, Samsiah M, et al. Foot care strategy for the newly diagnosed DM Type 2 patients with low educational and socio-economic background: a step towards future. Clin Ter. 2012;163(6):473-8.

Shrivastava PS, Shrivastava SR, Ramasamy J. An Epidemiological Study to Assess the Knowledge and Self Care Practices among Type 2 Diabetes Mellitus Patients Residing in Rural Areas of Tamil Nadu. Biol Med. 2015;S3:002.

Rajasekharan D, Kulkarni V, Unnikrishnan B, Kumar N, Holla R, Thapar R. Self-care activities among patients with diabetes attending a tertiary care hospital in Mangalore Karnataka, India. Ann Med Health Sci Res. 2015;5(1):59-64.

Mehta P, Godbole V, Gosai F, Brahmbhatt K. Knowledge of diabetes and self-care practices in chronic diabetic patients attending a tertiary care teaching hospital in India. NJIRM. 2014;5(2):91-7.

Raithatha SJ, Shankar SU, Dinesh K. Self-Care Practices among Diabetic Patients in Anand District of Gujarat. ISRN Family Med. 2014, Article ID743791:pp6.2014.

Saeed N. Frequency of patients with diabetes taking proper foot care according to international guidelines and its impact on their foot health. J Pak Med Assoc.2010;60:732-35.

Anselmo MI, Nery M, Parisi MCR. The effectiveness of educational practice in diabetic foot: a view from Brazil. Diabetology and Metabolic Syndrome. 2010;2:45.

Saeed N, Zafar J, Atta A. Frequency of patients with diabetes taking foot care according to international guidelines and its impact on their foot health. J Pak Med Assoc. 2020;60:732-5.

Baba M, Duff J, Foley L, Davies WA, Davies TME. A comparison of two methods of foot health education: The Fremantle Diabetes Study Phase II. Primary Care Diabetes. 2015;9(2):155-62.

Zagade T, Patil A. Effectiveness of Self Instructional Module on Knowledge RegardingPrevention of Microvascular and Macrovasclar Complications among Patients with Diabetes Mellitus. International Journal of Science and Research. 2014;3(5):902-8.

Thomas S, Mohite VR. Effectiveness of self instructional module on the knowledge regarding diabetic diet among diabetic patients. International Journal of Science and Research.2014;3(6):672-8.

Hartayu TS, Izham M, Suryawati S, Improving of Type 2 Diabetic Patients’ Knowledge, Attitude and Practice Towards Diabetes Self-care by Implementing Community-Based Interactive Approach-Diabetes Mellitus Strategy. BMC Research Notes. 2012;5:315-20.

Palaian S, Acharya LD, Rao PGM, Shankar PR, Nair NM, Nair NP. Knowledge, attitude, and practice outcomes: evaluating the impact of counselling in hospitalized diabetic patients in India. P and T Journal. 2006;31:383-96.