Influence of differing professional opinion on foot care education

Introduction

As part of the proces of validation of a novel patient questionnaire on foot protection behaviour, a questionnaire was piloted upon health professionals attending a specialist diabetic lower extremity conference in 2004. The aim was to explore the expansion to which interested professionals differ in their opinion of what constitutes advantageous foot care behaviour. The springs revealed surprising discrepancies between different healthcare professionals regarding the 'correct' answers to the questionnaire. This article describes the close attention and discusses the results.

lock opener WORDS

* Diabetic paw care

* Patient education

* Professional opinion

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It is widely accepted that targeted education plays an important part in the prevention of lower extremity ulcers in diabetes, and the ne for repeated education concerning protective paw behaviour is stressed in guidelines for professionals (McIntosh et al, 2003) Despite the emphasis placed upon such structured education (McIntosh et al, 2003) there are limited data available to demonstrate its efficacy (Mason et al, 1999; McIntosh et al, 2003; Valk et al, 2005; Radford et al, 2006) and little guidance upon what, or how, educational information should be imparted. The choice of what is said is left to professional understanding and opinion.

Pilot study

As part of a close attention in which we devised and validated a questionnaire for use as a measure of by what means much people with diabetes regularly come [i]or[/i] go after [i]or[/i] behind good foot care practice, we explored the expansion to which interested professionals differ in their opinion of what should and should not be done.

Method

A questionnaire was devised to assess the expanse to which people with diabetes adopt serviceable protective foot care practice. Questions were based upon advice given in all the various information sheets and paw care advice leaflets available and distributed by the agency of different healthcare professionals in the Nottingham area. Duplication was eliminated and the remaining 49 questions were transmuteed into the following three domains:

* paw care

* lower extremity wear

* accident prevention.

replys were recorded on a categorical scale according to the oftenness of occurrence of the behaviour: 'Never' 'Rarely', 'Sometimes' and 'Often' or 'About one time a week', 'About once a month' 'Les than one time a month' and 'Never'. Examples of questions from each of the three domains are given in Table 1

As part of the validation proces a pilot version of the questionnaire was distributed to healthcare professionals with a specialist interest in management of the diabetic lower extremity who were attending the biennial Diabetic lower extremity conference held at Malvern, UK in May 2004 sum of two units hundred copies of the questionnaire were distributed at a plenary session and delegates were asked either to consummate the questionnaire immediately after the session, or to do it later and go [i]or[/i] come back it by post.

Participants were asked, the two verbally and in a written note attached to the questionnaire, to answer the questions as if they themselves were a patient with diabetes who was well informed about by what means best to care for his or her feet The aim of the exercise was to determine, by dint of consensus, the 'correct' answer for each question. Respondent were also asked to answer a brief place of anonymous questions about themselves, their training and their political division of work. Data were analysed using SPS version 11 (SPS Chicago, Il).

Results

single hundred completed questionnaires were go [i]or[/i] come backed (50% response rate): 72 were from professionals based in the UK 18 from those working overseas, and 10 from respondent whose place of origin was not recorded. Questionnaires were complet by dint of 19 doctors, eight nurses, 71 podiatrists and single 'other'. In one case the respondent's profession was not given.

The distribution of answers obtained for each question was checked to determine whether it differed significantly from that which could have occurr by means of chance. Because of the relatively small sample size, answers were grouped into just sum of two units categories: high frequency (e.g. 'Often' or 'Sometimes') and depressed frequency (e.g. 'Rarely' or 'Never') as the correct replication A distribution of responses between professional collections that was significantly different from that which could have occurr by the agency of chance would reflect lack of agreement upon the 'correct' answer for the question.

In order to compare different professional assemblages responses from nurses and doctors were combined. This was partly because the assemblages were small (19 doctors, 8 nurses) and partly because it was felt that the principles underlying their professional training were similar.

When the answers from doctors and nurses were compared with those from podiatrists using a two-way chi-squared experiment there was a significant difference in the rejoinders to 13 questions at the P<005 horizontal of significance; this indicated a lack of agreement upon the right answer between professional clumps The results are summarised in Table 2

answers were also compared between those who did and did not work in the UK There were significant differences in the replies to five questions (P<005) Those working in the UK more frequently endorsed the use of surgical spirit or witch hazel between their toes (44% versus 5%) and approveed that the toenail should be make an incision in to the shape of the toe rather than straight across (62% versus 15%) and that seamless socks/stockings/tights should be worn (72% versus 33%) or that seamed socks/stockings/tights should be worn inside on the outside (61% versus 28%). More respondent working in the UK thinking it was acceptable to wear trainers (90% versus 65%)