Zhu Xiaoli, Tjhin Silvana, Goh Ling Jia, De Roza Jacqueline Giovanna, Chan Frederick H F, Yin Ruoyu, Lee Eng Sing, Griva Konstadina
Nursing Services, National Healthcare Group Polyclinics, Singapore
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
BMJ Open. 2024 Dec 31;14(12):e088088. doi: 10.1136/bmjopen-2024-088088.
To assess the factors associated with foot self-care behaviour and non-adherence to foot screening among patients with type 2 diabetes mellitus (T2DM).
A multicentre cross-sectional study was undertaken in seven primary care polyclinics in Singapore between October 2020 and December 2021.
275 adults (male 55.3%) with T2DM were included and assessed with the foot self-care behaviour questionnaire, including two aspects of foot care behaviour-preventative behaviour and potential damaging behaviour, and foot care confidence scale. Non-adherence to diabetic foot screening (DFS) attendance was also collected and assessed.
The average preventive behaviour score was 0.65 (SD 0.13, range 0-1) and potential damaging behaviour score was 0.43 (SD 0.09, range 0-1). Patients with greater foot care confidence (β=0.272) and being married (β=0.141) were more likely to adopt preventive behaviours, while patients aged between 21 and 45 years (β=0.136), having shorter DM duration (<5 years) (β=0.142) and moderate foot risk category (β=0.138) were more likely to adopt potential damaging behaviours. Non-adherence to DFS attendance was prevalent up to 43.3%. Non-adherence was higher in patients with higher HbA1c ≥7% (adjusted OR (AOR) 1.878, 95% CI 1.090 to 3.235) and moderate foot risk category (AOR 2.935, 95% CI 1.426 to 7.744).
Self-efficacy and being married are associated with preventive behaviours, while clinical parameters (eg, HbA1c, duration of DM and foot risk category) and age were associated with potential damaging behaviours and non-adherence to DFS appointments. Longitudinal studies are needed to confirm the findings for developing foot behavioural education to support foot care behaviours for primary care patients with T2DM.
评估2型糖尿病（T2DM）患者足部自我护理行为及未坚持足部筛查的相关因素。
2020年10月至2021年12月期间，在新加坡的7家基层医疗综合诊所开展了一项多中心横断面研究。
纳入275名成年T2DM患者（男性占55.3%），使用足部自我护理行为问卷进行评估，该问卷包括足部护理行为的两个方面——预防行为和潜在损伤行为，以及足部护理信心量表。还收集并评估了未坚持糖尿病足部筛查（DFS）的情况。
预防行为平均得分0.65（标准差0.13，范围0 - 1），潜在损伤行为平均得分0.43（标准差0.09，范围0 - 1）。足部护理信心较强（β = 0.272）和已婚（β = 0.141）的患者更有可能采取预防行为，而年龄在21至45岁之间（β = 0.136）、糖尿病病程较短（<5年）（β = 0.142）以及足部风险类别为中度（β = 0.138）的患者更有可能采取潜在损伤行为。未坚持DFS检查的情况普遍存在，高达43.3%。糖化血红蛋白（HbA1c）≥7%的患者（调整后比值比（AOR）1.878，95%置信区间1.090至3.235）以及足部风险类别为中度的患者（AOR 2.935，95%置信区间1.426至7.744）未坚持检查的比例更高。
自我效能感和婚姻状况与预防行为相关，而临床参数（如HbA1c、糖尿病病程和足部风险类别）及年龄与潜在损伤行为和未坚持DFS预约相关。需要进行纵向研究以证实这些发现，从而为制定足部行为教育提供依据，以支持基层医疗中T2DM患者的足部护理行为。
