Reducing Foot Ulcer Risk Through Screening and Patient Education

 Introduction

Diabetes is a disease that is widely known in the United States.  Our healthcare system has identified the importance of early intervention and prevention.  Unfortunately, less developed countries are unable to keep up with the trend and provide proactive care with various diagnoses.  In rural and underserved areas, access to healthcare is limited by factors decreased staffing, unavailable resources, and limited funding.  Secondary to the limiting factors, screening and prevention can become difficult.  Diabetes is now a manageable disease in the United States, but is not in developing countries.

In 2002, the Pan American Health Organization, an regional office of the World Health Organization, began to recognize the diabetes epidemic in Central America.  In 2003, a survey was conducted in Villa Nueva, Guatemala to assess the prevalence of diabetes in this town.  Of approximately 1400 individuals surveyed, researchers found there is approximately 8% diagnosed with diabetes.¹  A similar survey was conducted by PAHO in 2006 and found again 8% of those surveyed were diagnosed with diabetes and 24% classified as having impaired glucose intolerance.²  There is clearly a need to address diabetes in this population, but where do we come in?

My Capstone

Diagnosing diabetes is the main target of many efforts in Central America, the progression of the disease has not been thoroughly addressed.  If management improperly or without proper resources, diabetes can to lead to various serious complications.  Physical foot deformities, foot ulcers, and even amputation are common complications experience with individuals with diabetes.  The risk of developing such complications is astronomically higher in areas with limited resources.

I decided to frame my Capstone project around decreasing the risks of developing foot ulcers by clinical screening and patient education.  I compiled the evidence on the best methods to screen for diabetic foot ulcers and develop a tool that could be used in area with limited resources.  During my search, I choose five resources and merged the information to come up with the Foot Ulcer Risk Examination tool. Click here for list of referencesThis is a basic tool that utilizes a short clinical examination and patient history to stratify individuals into a risk category.  Once level of risk is determined, there are specific follow-up actions suggested to ensure proper management of the individual’s status.  The follow-up process is described in the flowchart.

 

Foot Ulcer Risk Examination tool:Foot Ulcer Risk Examination tool [English]

Foot Ulcer Risk Examination [Spanish]

Flowchart:Flowchart [English]                     Flowchart [Spanish]

 

In addition to a clinical screening, I developed patient education materials to assist individuals with regularly checking their feet.  The inside flaps of the brochure contained detailed information on “how to check your feet” and all information is summarized briefly in a checklist.  Developing culturally relevant materials was the most difficult aspect of this project.  Being unfamiliar to the lifestyle and cultural in Guatemala I tried to create something that was culturally neutral, but be a realistic resource for patients.  My health literacy assessment score was “superior at 85%,” but since that assessment was created for English language and American cultures it may not directly correlate to the population it was created for.  See attached Health Literacy Assessment form

 

Patient Education:Step by Step Guide to Better Foot Health [English]

Step by Step Guide to Better Foot Health [Spanish]

 

While in Guatemala, I will present the materials to various disciplines including physical therapists, nurses, and physicians.  I hope that following my presentation clinicians will have a valuable tool and resources to aid in decreasing the prevalence of foot ulcers in their communities.  I have prepared a short powerpoint presentation, but I expect to utilized a demonstration along with a question and answer session to deliver my materials.  Powerpoint for Guatemala

In order to evaluate my materials, I developed two different types of evaluations.  I created an evaluation and a script that allow my committee members to evaluate my work.  The script was created to simulate how I would deliver the tool to the clinicians in Guatemala.  My committee members were then asked to rate different aspects of the FURE tool, flowchart, and patient education material.  Space was also allowed for general comments and suggestions.  Some of the suggestions were determine to be very insightful and valuable, but were not addressed secondary to the limited scope of this project.

FURE script

Christina Young’s evaluation and comments

Ann Chamberlin’s evaluation and comments

Lisa Johnston’s evaluation and comments

 

The clinicians in Guatemala will be provided a similar, but shortened version of the evaluation.  Feedback from the clinicians in Guatemala will be posted after the trip.

Evaluation form for Guatemalan clinicians

 

 

 

 

1. Pan American Health Organization. The Central America Diabetes Initiative (CAMDI):Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua. Division of Disease Prevention and Control Program on Non-Communicable Diseases. 2002.
2. Pan American Health Organization. Survey of Diabetes, Hypertension, and Chronic Disease Risk Factors: Villa Nueva, Guatemala 2006. Washington, D.C: PAHO. 2007.