Can weekly ‘foot alerts’ using a bespoke mobile app improve patient diabetic foot care knowledge and practices in Kuwait?

Ali M Aldibbiat, Grace Messenger, Ebaa Al Ozairi, Imtiaz Hussain, Richard Masoetsa, Mohammad Assi

Research output: Contribution to conferenceAbstractpeer-review


Diabetic foot ulcers (DFU) are the leading cause of non-traumatic lower limb amputation, occurring every 20-secs. An important step in disrupting the pathway to amputation is improving patient awareness and foot care practices. Improvement in short-term knowledge and behaviour following education programs has been reported, but without sustained improvement. Two recent Cochrane reviews reported that not enough high-quality evidence existed to prove the effectiveness of patient education programs on the prevention of DFU, this is because there is a lack of evidence-based methods of education delivery. We propose that patients who receive weekly foot alerts alongside their regular Podiatry appointments will have better foot care knowledge and behaviours at 12-months compared to a control group.

This randomized, investigator-blinded, two-armed, study aims to pilot an innovative approach to education delivery. Participants will be included if they have been classified as high or moderate risk of developing DFU using the NICE classification system. 98 participants will be enrolled in this study with a 1:1 ratio between the control and intervention group. Control group subjects will receive usual diabetic foot care advice, including daily foot inspections, good footwear and foot health advice. Intervention subjects will receive usual diabetic foot care advice as well as a 10-minute audio-visual pre-recorded presentation and an application will be downloaded onto their smart phone. This application will deliver weekly foot alerts based on the presentation, repeating at 12-weekly intervals. Podiatry appointments will be scheduled depending on risk classification. Participants will complete an adapted Summary of Diabetes Self-Care Activities behaviour questionnaire and a Foot Care Knowledge Test prior at first Podiatry appointment and at 12 months.

Expected outcomes:
It is anticipated that participants in the intervention group will have improved foot care knowledge and practices when compared to the control group upon completion of the study. Furthermore, participants with a greater number of foot alert engagements i.e. accessing the information multiple times, will have better knowledge and behaviour compared to those accessing information less frequently. Finally, a correlation between improvement in foot care knowledge and behaviour and number of podiatry appointments will be present. We expect this to lead to improvement in patient’s long-term foot health.

This novel approach to diabetic foot care education could have a significant impact on patients' foot health and quality of life. Moreover, the financial burden to healthcare facilities and governments may be lessened by improving foot care behaviour and reducing DFU frequency.
Original languageEnglish
Publication statusE-pub ahead of print - 2019
EventDiabetic Foot Australia Annual meeting - Howard Smith Wharves, Brisbane City, Queensland, Australia
Duration: 8 Sep 201910 Sep 2019


ConferenceDiabetic Foot Australia Annual meeting
CityBrisbane City, Queensland,
Internet address


  • Diabetic foot
  • Education
  • mobile app


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