Knowledge, Attitudes, and Practices Associated With Diabetic Foot Prevention Among Rural Adults With Diabetes in North China.

Background: The diabetic foot is a global threat to public health because it can result in infection and amputation, as well as cause the patient to experience considerable pain and incur financial costs. The condition of patients with diabetic foot in North China is distinguished by more severe local ulcers, a worse prognosis, and a longer duration of disease than that of patients with diabetic foot in the south. Through appropriate preventive measures, the diabetic foot can be effectively avoided. This study assesses the existing knowledge, attitudes and practices associated with diabetic foot prevention among adults with diabetes living in rural areas of North China. Method: This cross-sectional survey included 1,080 rural adults from North China, cluster sampled 12 villages and surveyed diabetic patients without diabetic foot who participated in community diabetes management. The self-administered knowledge and attitude questionnaire and the Chinese version of the Nottingham Assessment of Functional Foot-care Questionnaire were used. Result: Of the 1,080 subjects, 51.6% received moderate knowledge scores, 63.9% had a positive attitude and 71.4% received poor practice scores. In terms of knowledge, parameters of knowledge about foot examinations and treatment of foot problems showed the lowest scores. In terms of practice, in line with the results of the low knowledge score, parameters of the pursuit of medical treatment for foot problems and routine foot examinations were associated with the lowest scores. Multiple regression analysis revealed that participants who were current smokers (β: -0.049, 95% CI: -0.088 to -0.011) had lower knowledge scores than those who never smoke; participants who were current smokers (β: -0.818, 95% CI: -1.067 to -0.569) and past smokers (β: -0.299, 95% CI: -0.485 to -0.112) had lower attitude scores than those who had never smoked; participants who had higher knowledge scores (β: 1.964, 95% CI: 1.572-2.356) achieved higher scores on attitudes; women had better practice scores than men (β: 0.180, 95% CI: 0.122-0.239); patients with a long diabetes duration (6-10 years) had better practice scores than those who had a short diabetes duration (<2 years; β: 0.072, 95% CI: 0.012-0.131). Knowledge (β: 0.130, 95% CI: 0.001-0.258) and attitudes (β: 0.268, 95% CI: 0.249-0.287) were significantly associated with good practices. Conclusions: Increasing knowledge regarding diabetic foot would help instill positive attitudes and cultivate better practices toward diabetic foot prevention. The results of this study may help guide future promotional resources to those groups most in need, which may help lower the incidence of diabetic foot among adults in North China.