Effectiveness of pictorial educational intervention on foot care among individuals having type 2 diabetes at slums of Karachi, Pakistan: asingle blinded randomized control trial.

BACKGROUND

Diabetes elevates the chance of severe health complications, such as Diabetic Foot (DF), which detrimentally affects quality of life. A significant proportion of diabetes mellitus patients, particularly in the slums of Karachi, lack awareness of foot care, hence increasing their risk of foot ulcers and amputations. This exacerbates the healthcare cost owing to avoidable complications of diabetes.

AIM: The primary objective of this study was to evaluate the effectiveness of a pictorial infographic-based foot care education intervention among patients with diabetes in the slums of Karachi, Pakistan. By assessing the impact of this intervention, we aimed to provide valuable insights into the design of future diabetes care and education programs.

METHODOLOGY: A single-blinded randomized control trial was conducted at one clinic of the primary healthcare organization SINA, providing primary healthcare services in slums. Using repeated measures of ANOVA to evaluate the effect of group (intervention vs. control), time (pre-and post), and their interaction on scores and pair t-test to check the mean difference of scores in intervention and control group at baseline and after 3 months. The data were cleaned and analyzed in STATA 17.

RESULTS

Of 180 individuals, 90 were in each arm-intervention and control. In the intervention arm, 83 completed follow-up and 77 in the control. In the control and interventional groups, 77.9% and 80.7% of 160 participants were female. Participants' mean age, BMI, and diagnosis years were 54.92 ± 10.41 years, 28.99 ± 6.22, and 7.99 ± 6, respectively. The repeated measures ANOVA showed significant main effects for both groups (F (1, 158) = 45.65, p < 0.0001) and time (F(1, 158) = 172.30, p < 0.0001), showing significant changes in scores. A substantial interaction effect between group and time indicates that ratings changed differently over time for the two groups. The intervention affected the groups differently, with considerable variations over time. Additionally, after education intervention, the intervention arm showed a significant improvement in mean difference (mean difference: 3.53, 95% CI 3.11-3.96, p < 0.001) compared to the control group (mean difference: 0.87, 95% CI 0.34-1.40, p < 0.001) from baseline.

CONCLUSION

Education had a crucial role in positively impacting patient behavior. Therefore, patients must be actively involved in their healthcare education awareness, focusing more on modifying their behavior.