Knowledge and Practice Regarding Foot Care in Patients with Diabetes Mellitus Attending Diabetic Clinics in Health Centers in the Kingdom of Bahrain

Background: Diabetes Mellitus (DM) is a serious chronic disease. The prevalence of diabetes in Bahrain in 2007 was 14.3%. One of the most important complications of diabetes is foot problems. In Bahrain the estimated prevalence of diabetic peripheral neuropathy was 36.6%, peripheral vascular disease 11.8% and foot ulceration 4.75%. Although there is a large amount of literature on the diabetic foot and the importance of foot care, there is a lack of population based study of foot care knowledge and practice. The aim of this study is to assess the knowledge and describe the practice of foot care in diabetic patients in diabetic clinic. Design: A cross–sectional survey in diabetic clinics in local health centers in Bahrain. Setting: Diabetic clinic, Primary health centers, The Kingdom of Bahrain. Methods: The target population was all diabetic patients attending diabetic clinics in primary health care in Bahrain during the period of 15^th July, 2008 till 15th, October, 2008. The questionnaires were filled by direct interview of 400 patients, 100 patients from each health region. The questionnaire contained demographic data, questions about knowledge and practice of diabetic foot care. Results: The mean knowledge score was 8 (SD 2) out of 11. Only 33% of the patients knew that there is no relationship between diabetes and flat feet. 44% of the patients were unaware that they should inspect their feet daily. 38.7% did not think that they should inspect their footwear every time they were worn. Higher knowledge score was found in Bahraini patients (P=.000), Patients with high educational level (P=.004) and in patients with less than 20 years duration of diabetes (P=.001). On the other hand, there were no associations between the knowledge score and gender, glycemic control or having previous foot problem. Feet inspection was practiced by 66.5% of the patients. 86.8% were washing their feet daily and 78.5% were washing their feet in warm water. Practices that put patients at risk included trimming toenails straight across, not having their feet measured when they last bought footwear and walking barefoot regularly. Conclusion: This study revealed a good knowledge score in this study (mean 8, SD 2), but are still deficiencies in knowledge about the frequency of foot inspection (44%) and awareness regarding inspection of the inside of footwear for object and torn lining (38.7%). Feet inspection was practiced by 66.5% of the patients, 86.8% were washing their feet daily and 78.5% were washing their feet in warm water. Findings from this study can be used in implementing health education programs on foot care for diabetic patients to improve their knowledge and practice.