Abstract
BackgroundThis study aimed to determine knowledge of national guidelines for diabetic foot assessment and risk stratification by rural and remote healthcare professionals in Western Australia and their implementation in practice. Assessment of diabetic foot knowledge, availability of equipment and delivery of foot care education in a primary healthcare setting at baseline enabled evaluation of the effectiveness of a diabetic foot education and training program for generalist healthcare professionals.MethodsThis study employed a quasi-experimental pre-test/post-test study design. Healthcare practitioners’ knowledge, attitudes and practice of diabetic foot assessment, diabetic foot risks, risk stratification, and use of the 2011 National Health and Medical Research Council Guidelines were investigated with an electronic pre-test survey. Healthcare professionals then undertook a 3-h education and training workshop before completing the electronic post-test knowledge, attitudes and practice survey. Comparison of pre-test/post-test survey findings was used to assess the change in knowledge, attitudes and intended practice due to the workshops.ResultsTwo hundred and forty-six healthcare professionals from two rural and remote health regions of Western Australia participated in training workshops. Monofilaments and diabetes foot care education brochures, particularly brochures for Aboriginal people, were reported as not readily available in rural and remote health services. For most participants (58 %), their post-test knowledge score increased significantly from the pre-test score. Use of the Guidelines in clinical settings was low (19 %). The healthcare professionals’ baseline diabetic foot knowledge was adequate to correctly identify the high risk category. However, stratification of the intermediate risk category was poor, even after training.ConclusionThis study reports the first assessment of Western Australia’s rural and remote health professionals’ knowledge, attitudes and practices regarding the diabetic foot. It shows that without training, generalists’ levels of knowledge concerning the diabetic foot was low and they were unlikely to assess foot risk. The findings from this study in a rural and remote setting cast doubt on the ability of generalist healthcare professionals to stratify risk appropriately, especially for those at intermediate risk, without clinical decision support tools.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-016-0157-2) contains supplementary material, which is available to authorized users.
Highlights
This study aimed to determine knowledge of national guidelines for diabetic foot assessment and risk stratification by rural and remote healthcare professionals in Western Australia and their implementation in practice
Healthcare practitioners’ knowledge, attitudes and practices (KAP) of diabetic foot risks, assessment procedures, risk stratification, and use of the 2011 National Health and Medical Research Council (NHMRC) Guidelines were investigated with an electronic pre-test survey [43]
Study population Two hundred and forty-six rural and remote healthcare professionals from two country health regions of Western Australia participated in the diabetic foot workshops
Summary
This study aimed to determine knowledge of national guidelines for diabetic foot assessment and risk stratification by rural and remote healthcare professionals in Western Australia and their implementation in practice. The 2011 National Health and Medical Research Council (NHMRC) National Evidence- Based Guideline on Prevention, Identification and Management of Foot Complications in Diabetes (Guideline) provided an expert consensus opinion that “[in Australia] any suitably trained health professional may perform the [foot] risk assessment [stratification]” [3]. In Australia, there is limited evidence available regarding rural and remote healthcare professionals’ diabetic foot knowledge and practice, or on approaches to upskilling health generalists in rural practice about the diabetic foot. The Western Australian public health system covers 2.5 million square kilometres and is the largest area in the world covered by a single health authority, so access to specialist podiatry for those living remotely is very difficult, with a strong rationale for the training of generalists to identify foot problems early [14]
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