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Long-Term Effects of Multimedia Education and "Foot Alerts" Through the MyU App on Diabetic Foot Care in Individuals
Ameenah Alawadhi1, Kay Scarsbrook Khan2,3, Grace Messenger2,4
1Clinical Care Research and Trials Unit, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait City, 1180, Kuwait, 965 22242999 ext 3111.
Background:
Diabetic foot ulceration (DFU) is the leading cause of nontraumatic amputations in people with diabetes. Research shows that improving patient awareness can result in short-term improvements, but Cochrane reviews report insufficient high-quality evidence.
Objective:
This study aims to investigate the effects of multimedia presentation and smartphone alerts to enhance long-term knowledge and foot care behaviors in individuals at moderate-to-high risk of DFU.
Methods:
Participants were randomized to a control group, receiving usual diabetic foot care advice (n=40), or an intervention group, receiving a multimedia diabetic foot care presentation and regular "foot alerts" through the MyU smartphone app on top of usual care (n=37). Patient's knowledge and behaviors related to diabetic foot care were assessed at baseline and after 12 months. Repeated measures ANOVA was conducted in both intention-to-treat and per-protocol analyses to evaluate the intervention's effectiveness.
Results:
The findings were consistent across intention-to-treat and per-protocol analyses. In the intervention group, the number of podiatry visits was positively correlated with improved foot care behavior (r=0.408; P=.02), while the control group showed a negative correlation (r=-0.402; P=.02). No significant correlations were observed with knowledge scores. Although no significant time×group interactions were seen, the main effects of time were found for both knowledge (η²=0.12; P=.004) and behavior scores (η²=0.31; P<.001). Post hoc analysis showed a decline in knowledge scores in the control group (Cohen d=-0.24; P=.007) and improvements in behavior scores in both groups (Cohen d: intervention=0.61, control=0.63; all P<.001).
Conclusions:
The MyU app-based multimedia intervention was associated with improved foot care behaviors over 12 months, indicating potential benefits as an adjunct to usual diabetic foot care. However, no significant changes in diabetic foot care knowledge were observed. These findings suggest that while the applied digital multimedia tool may support behavior change, further research is needed to enhance knowledge retention and clinical impact. The study revealed that multimedia education alone may not be effective for long-term improvement in foot self-care knowledge and behavior among individuals at moderate-high DFU risk, but the reinforcement of educational material during follow-up podiatry visits could be effective.
