title: Improving rural and remote practitioners' knowledge of the diabetic foot: findings from an educational intervention.
abstract: BACKGROUND
  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. 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.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  Two 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.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: Western Australian Centre for Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia.
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Schoen
authors.affiliation: Western Australian Centre for Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia.
authors.forename: Kaniz
authors.initials: K
authors.lastname: Gausia
authors.affiliation: Centre for Software Practice, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia.
authors.forename: David G
authors.initials: DG
authors.lastname: Glance
authors.affiliation: Western Australian Centre for Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia.
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D017719:Diabetic Foot / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D004502:Education, Medical, Continuing / Q000379:methods / Q000458:organization & administration*; D004521:Educational Measurement / Q000379:methods; D005260:Female; D006282:Health Personnel / Q000193:education / Q000592:standards*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards; D018570:Risk Assessment / Q000592:standards; D019035:Rural Health Services / Q000592:standards*; D014904:Western Australia; D055815:Young Adult
keywords: Attitude; Diabetic foot; Knowledge; Practice; Risk stratification