A nurse-led self-efficacy–based hybrid diabetic foot self-management education program for individuals with diabetes: a randomized controlled trial

Abstract

Aim: This study aimed to examine the effect of a nurse-led self-efficacy–based hybrid diabetic foot self-management education program on diabetic foot knowledge, foot care behaviors, adaptation to chronic illness, and self-efficacy among adults with type 2 diabetes mellitus (T2DM). Design: This study was a two-arm, single-center and single-blind, randomized controlled trial. Methods: The study sample consisted of 48 adults with T2DM assigned to the intervention (n = 25) and control (n = 23) groups using block randomization. The study was conducted at a tertiary hospital outpatient clinic in Ankara. The intervention group received a nurse-led self-efficacy–based hybrid foot self-management education program for eight weeks. This was a three-stage program comprising face-to-face sessions, WhatsApp-mediated interactions, and educational content provided through a YouTube channel, and it included a follow-up component. Baseline and follow-up data were collected at baseline, week 4, and week 8 using the Diabetic Foot Knowledge Scale (DFKS), Foot Care Behavior Scale (FCBS), Adaptation to Chronic Illness Scale (ACIS), and Diabetic Foot Care Self-Efficacy Scale (DFCSES). Data were analyzed using descriptive statistics and Repeated Measures ANOVA. Results: Significant Group × Time interaction effects were found for DFKS (F = 37.50, p < 0.05), FCBS (F = 12.8, p < 0.05), and DFCSES (F = 3.87, p < 0.05), indicating greater improvement in the intervention group compared to the control group. No significant Group × Time differences were found in ACIS (F = 0.071, p > 0.05). Conclusion: The self-efficacy-based, nurse-led hybrid diabetic foot self-management education program significantly improved diabetic foot knowledge, foot care behaviors, and self-efficacy in adults with T2DM. These findings support incorporating this education program into routine diabetes management to promote sustainable self-care and reduce the risk of diabetic foot complications. Patient or public contribution: Patients and public were not involved in this study. This study was registered on ClinicalTrials.gov (Ref. No: NCT05974592, Registered on July 26, 2023).