title: Health education programmes to improve foot self-care practices and foot problems among older people with diabetes: a systematic review.
abstract: OBJECTIVE
  To assess the effectiveness of health education programmes to improve foot self-care practices and foot problems among older people with diabetes.
  
  
  BACKGROUND
  The complications of diabetes among older people are a major health concern. Foot problems such as neuropathy, ulcer and ultimately amputation are a great burden on older people with diabetes. Diabetes foot education programmes can influence the behaviour of older people in practising foot self-care and controlling the foot problems. However, the educational approaches used by the educators are different. Therefore, it is important to assess the education programmes from various evidence-based practices.
  
  
  METHODS
  Six databases, EBSCOhost medical collections (MEDLINE, CINAHL, Psychology and Behavioral Sciences Collection), SAGE, Wiley Online Library, ScienceDirect, SpringerLink and Web of Science, were used to search for articles published from January 2000 to March 2015. The search was based on the inclusion criteria and keywords including 'foot', 'care' and 'diabetes'. Fourteen studies were assessed and reviewed in the final stage.
  
  
  CONCLUSIONS
  Health education programmes varied according to their design, setting, approach, outcome measured and results. Foot assessment, verbal and written instructions and discussion were proved to improve the foot self-care and foot problems. Subsequent follow-ups and evaluations had a significant effect. An improvement was observed in foot self-care scores and foot problems (such as neuropathy, foot disability, lesion, ulcer, tinea pedis and callus grade) after implementation of the health education programme.
  
  
  CONCLUSIONS
  The findings of this study support the claim that a health education programme increases the foot self-care scores and reduces the foot problems. However, there were certain methodological concerns in the reviewed articles, indicating the need for further evaluation. In future, researchers and practitioners must implement a vigorous education programme focusing on diabetes foot self-care among the older population.
authors.affiliation: Nursing Department, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia.|Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
authors.forename: Siti Khuzaimah
authors.initials: SK
authors.lastname: Ahmad Sharoni
authors.affiliation: Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
authors.forename: Halimatus Sakdiah
authors.initials: HS
authors.lastname: Minhat
authors.affiliation: Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
authors.forename: Nor Afiah
authors.initials: NA
authors.lastname: Mohd Zulkefli
authors.affiliation: Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
authors.forename: Anisah
authors.initials: A
authors.lastname: Baharom
mesh_terms: D017719:Diabetic Foot / Q000517:prevention & control*; D006266:Health Education; D006801:Humans; D012648:Self Care
keywords: diabetes; foot problems; foot self-care; health education; older people; systematic review