الفهرس 
Introduction and Aim of the StudyOnly 14 pages are availabe for public view
 |  | from | 349 |  |  |
| | | from | 349 | | |
Abstract
Diabetes is a common chronic disease affecting older people, and it is becoming a global health concern. The IDF reported that 425 million people diagnosed with DM in 2017, the number is projected to rise to 642 million by 2040 and the number of diabetic elderly is expected to increase to 252.8 million by 2035. The prevalence of diabetes is expected to increase exponentially in the next 20 years for developing countries. This has largely been attributed to unhealthy lifestyles, ageing, globalization and urbanization (Sharoni et al.,2017; IDF,2017).
High prevalence of DM is associated with increase in its complications among diabetic elderly patients. Diabetic foot problems as one important complication of DM constitute an increasing public health problem and are a leading cause of hospital admission, amputation and mortality in diabetic patients, the peak prevalence being between 60 and 80 years of age. Worldwide, approximately 40-60% of all non-traumatic amputations of the lower extremities are performed in patients with diabetes (Marzouk et al.,2017).
Health Belief Model that was selected as a theoretical framework for this study is one of the most effective models of health education which mainly focuses on disease prevention. Previous studies showed successful application of HBM in explanation and prediction of preventive health behavior. Based on HBM, individual must believe that is susceptible to a disease (perceived susceptibility), understands the risk and it’s sever to his life (perceived severity). So, understanding individuals’ view points and beliefs is essential for developing the strategies of controlling diabetes (Dehghani-Tafti et al.,2015).
Aim of the study:
This study aimed to evaluate the effect of health belief model on prevention of diabetic foot among elderly through :
1-Assessing elderly knowledge toward diabetes in general and diabetic foot specifically.
2- Assessing elderly health beliefs toward diabetes and diabetic foot.
3-Assessing level of elderly compliance with diabetes therapeutic regimen.
4- Assessing elderly foot self-care practices.
5-Designing and implementing program based on HBM for diabetic elderly, according to their needs.
6- Evaluating the effectiveness of HBM based program on elderly knowledge, health beliefs toward diabetes and diabetic foot, compliance with diabetes therapeutic health behaviors and practices regarding foot self-care.
I.Research Design:
A quasi-experimental research design (One group pre/post test and follow-up) was used in the current study.
II.Technical Design:
The technical design includes; the setting, subjects & tools were used in the study.
A)Research setting:-
The study was conducted at the diabetes & endocrine clinic affiliated to Beni-Suief university hospital.
B)Sampling: Type:
Non-propability (purposive) sample was used in the current study. The number of diabetics who visited diabetes and endocrine out-patient clinic was 436 (from registration record) through the year 2017. In 2018 the flow rate of cases per day in the clinic approximatly 1-8 cases both type I and type II DM (either newly diagnosed or follow-up cases). The sample size was calculated using the following equation:
The sample size according the equation was 77 elderly both males and females, the inclusion criteria of the patients containing those who are aged 60 years and above, free from foot ulcer, and other complications in their feet, willing to participate in the study and able to comprehend and communicate. 10% (7) of the subjects were excluded in a pilot study.
C)Tools for data collection:-
First tool: Structured interviewing questionnaire was developed by the researcher in Arabic language after reviewing the literature and experts opinion and based on HBM, it comprised the following parts;
Part I: Demographic characteristics of the elderly including age, gender, marital status, occupation, monthly income, level of education, and residence (Q1 to Q7).
Part II: Medical history of the elderly including age of onset of DM, duration of DM, associated comorbidity, current treatment and family history of diabetes (Q8 to Q12).
Part III: Assessing elderly knowledge (Pre/ Post /Follow-up) (Q1 to Q42) through asking questions. It covered the elderly knowledge about diabetes in general, diabetic foot and foot care.
Part IV: The therapeutic health behaviors of the elderly (Pre / Post / follow-up). It was developed by the researcher after reviewing the literature and composed of 26 items about compliance of the elderly with diabetes therapeutic regimen (compliance with treatment regimen, dietary regimen, exercise, periodic check up, periodic laboratory tests for glucose in blood/urine and smoking cessation).
Second tool: The health belief model scale (Pre /Post /Follow-up) was adapted from Sharifirad et al. (2007). The main HBM sub constructs which used in this study were perceived susceptibility (possibility of diabetes complications including diabetic foot occurrence (9 items), perceived severity (perceived seriousness of diabetes and diabetic foot (9 items), perceived benefits (benefits of adopting preventive health behaviors (9 items), and perceived barriers (barriers of adopting preventive health behaviors (12 items).
Third tool: Diabetic elderly foot self-care practices observational checklist was developed by the researcher to collect information regarding foot care practiced by the elderly.
Pilot study:
A pilot study was carried out on 10% (7) of elderly to test the study tools for clarity, feasibility, applicability, and time required to fill out the questionnaires. The necessary modifications were done through omission of unneeded or repeated questions and improvements were made prior to data collection according to the pilot study results. The sample of the elderly who participated in the pilot study was excluded from the main study sample.
The findings of the present study could be summarized as follows:
• Total number of the elderly was 70, majority (84.3%) of them their ages ranged from 60 to less than 65 years old with mean age 64.44 ± 3.65, and more than three fifths (62.9%) of them were females. More than half (58.6%) of the elderly were housewives and more than three fifths (61.4%) of them didn’t earn enough monthly income. In relation to level of education and residence, nearly half (48.6%) of the elderly were illiterate and less than three quarters (74.3%) belonged to rural areas.
• Regarding medical history, less than three quarters (74.3%) had DM at age from 41 to 60 years and the highest percentage (44.3 % ) had a duration of disease less than 5 years. Regarding associated comorbidity, current treatment and family history, less than two- thirds of the elderly had associated comorbidity with DM (65.7%) and more than three quarters depending on oral hypoglycemic tablets (77.1%). Regarding family history, more than half (51.4%) of the elderly have positive family history of diabetes.
• As regards to the total correct elderly knowledge regarding diabetes in general, diabetic foot and foot care, only 25.7% of the elderly had satisfactory knowledge pre program, and this percentage improved to 67.1% post program, then decreased to 55.7% in follow- up after two months with highly significance at p value<0.001.
• In accordance to the total elderly compliance with therapeutic health behaviors, 55.7% of the elderly had poor compliance with diabetes therapeutic health behaviors pre program, this percentage decreased to 21.4% and 22.9% during post program and follow-up after two months respectively with highly significance at p value<0.001.
• In relation to the total elderly health beliefs toward diabetes and diabetic foot, Only 32.9% of the elderly had positive beliefs pre program versus to 80.0%, 77.1% during post program and follow-up after two months respectively with highly significance at p value<0.001.
• Considering to the total elderly foot care practices, 40.0% of the elderly had good level of practices pre program, this percentage improved to 84.3% during post program, then changed to 77.1% in follow- up after two months respectively with highly significance at p value<0.001.
• In the current study, it was found that, there was positive correlation between elderly’s total knowledge and their HBM constructs (perceived susceptibility, severity, benefits and barriers) pre/post program and follow-up after two months at P<0.001.
• There was positive correlation between elderly’s total foot self-care practices and their HBM constructs (perceived susceptibility, severity, benefits and barriers ) pre/post program and follow- up after two months at P<0.001.
• The study finding indicated that, there was positive correlation between elderly’s total compliance with therapeutic health behaviors and their HBM constructs (perceived susceptibility, severity, benefits and barriers) pre/post program and follow- up after two months at P<0.001.
• Additionally, the study clarified that, there was a positive highly statistically significant correlation between total knowledge and total therapeutic health behaviors in pre/post program implementation and in follow- up. Also, there was a positive highly statistically significant correlation between total knowledge and total foot self- care practices in pre/post program implementation and in follow up.