2019 HSR&D/QUERI National Conference

4087 — Assessing Foot Self-Care Behavior: The Validity and Reliability of a Foot Self-Care Survey in Veterans with Diabetic Neuropathy.

Lead/Presenter: Bernardo Da Silva
All Authors: Da Silva B (VA New York Harbor Healthcare System), Nicholson A (VA New York Harbor Healthcare System), Natarajan S (VA New York Harbor Healthcare System, New York University School of Medicine)

Diabetic neuropathy, the most common complication of diabetes, puts patients at high risk for diabetic foot ulcer (DFU) and amputation. Proper foot self-care is considered crucial to prevent diabetes-related foot complications. This study reports on the validity and reliability of a modified survey to determine patient adherence to foot self-care behaviors.

We used data from the PATRIOT trial testing a primary prevention strategy to prevent DFUs among at-risk Veterans (n = 387). All participants completed the 14-item VA Foot Self-Care Survey (validated in patients with prior DFU) during in-person visits. Internal consistency was determined by calculating Cronbach alpha. Convergent validity was assessed from the correlation between the instrument's footcare skills scores and patients' foot self-care proficiency scores from a separate free-recall demonstration in which participants demonstrated their foot-care. Discriminant validity was evaluated by comparing the correlations between patient foot self-care scores and patient height separately. Reliability was assessed by comparison with the control group's scores at the 6-month follow-up visit.

The 14-item survey demonstrated strong internal consistency (alpha = 0.66). Shortening the survey to include only the 6-item basic foot self-care behaviors further increased internal consistency (alpha = 0.74). Significant correlations between self-care demonstration and basic footcare skill scores (0.30, p = < .0001) and with extended footcare skill scores (0.21, p-value = < .0001) were observed. No correlation between height and basic foot-care scores (-0.071, p-value = .16) or between extended foot-care scores (-0.040, p-value = .43) were noted. Test-retest reliabilities for the 6-item basic (0.67, p-value = < .0001) and the 4-item extended (0.55, p-value = < .0001) foot self-care behaviors were strong.

The 14-item foot self-care survey demonstrated satisfactory validity and internal consistency for assessing adherence to foot self-care behaviors among primary prevention diabetic veterans. The 6-item basic measure had better psychometric properties.

The 6-item measure is valid and reliable for efficiently assessing foot self-care in Veterans at risk of developing a DFU. Future implementation studies should incorporate the 6-item measure in usual VA care settings and target poorly adherent patients for tailored care to reduce the risk of incident DFU in such Veterans.