Educational technology validity to prevent diabetes-related foot disease

Vilhena, Bianca Jardim; Silva, Denise Maria Guerreiro Vieira da; Ramos, Flávia Regina Souza; Boell, Julia Estela Willrich; Arruda, Cecília

doi:10.1590/2177-9465-EAN-2023-0060en

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RESEARCH • Esc. Anna. Nery 27 • 2023 • https://doi.org/10.1590/2177-9465-EAN-2023-0060en copy

Educational technology validity to prevent diabetes-related foot disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

to validate the content of the Educational Technology (LISTEN, SEE, DO) for the prevention of foot alterations in people with Diabetes Mellitus.

Method

methodological research for content validation. Judges were selected from the Lattes/Conselho Nacional de Desenvolvimento Científico e Tecnológico Platform using the expression “diabetic foot” and including advanced search filters, resulting in 51 potential judges, of which 32 judges responded. The results were analyzed in relation to the Committee's Concordance Rate (CCR) and the Content Validity Index (CVI) of its sub-items.

Results

all items of the educational technology reached the previously established indices with experts' agreement on the evaluated content (CCR) being higher than 96% in each item, and the CVI being higher than 0.90 in each sub-item.

Conclusion and implications for practice

the Educational Technology LISTEN, SEE, DO met the previously established criteria for content validation and was considered by judges to have appropriate item composition, with clear and relevant sub-items. The validated technology provides material for preventing diabetic foot using innovative strategies that stimulate people in an auditory, visual, and kinesthetic way.

Keywords:
Diabetes Mellitus; Diabetic Foot; Nursing Methodology Research; Educational Technology; Validation Study

Assessment items and sub-items	CVI ^* * CVI: Content Validity Index; Clarity	CVI ^ CAR: Committee Agreement Rate. Relevance
ITEM 1 - What to look for on feet daily – CAR 98.9%**
1.1 Foot moisture	0.93	0.96
1.2 Presence of injuries: scratches, wounds	0.93	0.96
1.3 Presence of calluses	0.96	0.96
1.4 Presence of cracks in the heels	0.96	0.96
1.5 Presence of blisters	0.96	0.93
1.6 Presence of changes between the fingers	0.96	0.93
1.7 Nail size and shape	1	0.96
ITEM 2 - What product to use to wash the feet and water temperature CAR 98.9%
2.1. Use bar or liquid soaps that are neutral - fragrance-free and glycerin-free	0.93	0.93
2.2 Wash with warm water – test the temperature on the inside of the arm	1	1
ITEM 3 - How to dry the feet - CAR 100%
3.1. Do not leave the feet damp or wet	0.96	0.96
3.2. Dry the entire foot with a soft towel, especially between the toes	1	0.96
ITEM 4 - How to moisturize the skin on the feet - CAR 100%
4. 1. Apply moisturizer only after washing the feet	0.90	1
4. 2. Apply moisturizing cream to the feet at least twice a day	0.96	1
4. 3. Apply the moisturizer gently, in circular movements, including the back of the feet, soles of the feet, heels and over the toes	1	1
4. 4. Do not apply moisturizer between the fingers	0.96	0.96
ITEM 5 - How to cut the nails - CAR 100%
5. 1. Cut toenails only with appropriate instruments: scissors, clippers or nail clippers	0.96	0.93
5. 2. Request help cutting the toenails	1	1
5. 3. Cut the nails straight and never rounded	0.90	1
5. 4. Cut to medium size - on the top line of the finger	0.93	1
5. 5. Do not let the nails be too long	1	0.93
ITEM 6 - What to do with calluses and cuticles – CAR 100%
6.1. Never remove cuticles	1	0.96
6.2. Never remove calluses	1	1
6.3. Never soak the feet (foot bath)	0.96	1
6.4. Consult a professional, preferably a podiatrist, if there are calluses or problems with the cuticles	1	1
6.5. Wear suitable shoes that do not cause calluses	1	0.96
ITEM 7 - What types of shoes are suitable – CAR 100%
7.1. Shoes should be soft and comfortable - never wear tight shoes	1	1
7.2. The toe of the shoe must have a rounded or square shape and never a “thin toe”.	1	1
7.3. Shoes must be seamless (internal seams can cause injuries or calluses)	1	1
7.4. Prefer closed shoes to protect the feet	1	1
7. 5. Avoid walking barefoot or wearing high-heeled shoes	1	1
ITEM 8 - What type of socks to use – CAR 96.9%
8.1. Wear cotton (soft) socks and not nylon	1	1
8.2. Wear socks without elastic at the top	0.96	0.96
8.3. Wear seamless socks	1	1
8.4. Prefer light colored socks - helps identify the presence of secretions and bleeding	1	0.96

Item	Subitems
Item	Previous version	Final version
1. What to look for on the feet daily	1.2 Presence of injuries: scratches, wounds	1.2. Presence of injuries (cuts, scrapes, wounds), bleeding or secretions
2. What product to use to wash the feet and water temperature	2.1. Use bar or liquid soaps that are neutral - fragrance-free and glycerin-free	2.1. Use bar or liquid soaps that are neutral, fragrance-free and preferably glycerin
		2.2. Wash with warm water (test water temperature on the inside of the forearm). Very hot water can cause burns or blisters when sensitivity is reduced
	2.2 Wash with warm water – test the temperature on the inside of the arm
3. How to dry the feet		No changes
4. How to use moisturizing creams?	4.3. Apply the moisturizing cream gently, in circular movements, including the back of the feet, soles of the feet, heels and over the toes	4.3. Apply the moisturizing cream to the top of the feet, soles, heels and toes. Do not apply between the fingers (promotes excessive humidity and the proliferation of fungi/bacteria)
	4.4. Do not apply moisturizer between the fingers
	4.4. Do not apply moisturizer between the fingers	4.5. Wait for the moisturizer to absorb/dry before walking (avoid slipping)
5. How to cut the nails	5. 1. Cut the toenails only with appropriate instruments: scissors, clippers or nail clippers	5.1. Cut toenails only with appropriate instruments: blunt scissors, clippers or nail clippers
	5. 4. Cut to medium size - on the top line of the finger	5.4. Nails must be cut straight across the top of the finger and never rounded (to prevent them from becoming “ingrown”)
	5.5. Do not let the nails be too long
	5.5. Do not let the nails be too long	5.5. Cut the nails whenever you consider it necessary, i.e., when the nail extends beyond the top of the fingers
6. What to do with calluses and cuticles		No changes
7. What types of shoes are suitable		No changes
8. What type of socks to use	8.1. Wear cotton (soft) socks and not nylon	8.1. Wear soft cotton socks (do not wear nylon socks or other synthetic materials)
	8.1. Wear cotton (soft) socks and not nylon	8.2. Wear socks without elastic (elastic can tighten/garrot the ankle and compromise blood circulation in the feet)
	8.2. Wear socks without elastic at the top
	8.2. Wear socks without elastic at the top	8.5. Change socks after each use

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[1] Corresponding author: Denise Maria Guerreiro Vieira da Silva E-mail: denise_guerreiro@hotmail.com