The effects of a realistic acceptance enhancing program on self-care behaviors and foot health status among persons with type 2 diabetes mellitus

Diabetic Foot Ulcers (DFU) are among the diabetes mellitus (DM)-related problems with peripheral neuropathic symptoms and arterial function deterioration, as is a leading cause of preventable lower limb amputation. Promoting self-care behavior is essential for people with DM to control the progression of DFU and prevent loss of limbs. Although self-care is a key to living with chronic illness, actual engagement is difficult because it entails aforethought and effort in addressing physical, mental, and emotional health. This study was a randomized controlled trail (RCT) with a repeated measures design to examine the effects of a Realistic Acceptance Enhancing (RAE) program. This program was developed based on the theory of self-care of chronic illness and the concepts of acceptance and commitment (ACT). Ninety-six participants who met the inclusion criteria were recruited at a Center of Excellence of a university hospital in a central province of Thailand. The sample was randomly assigned to control (n = 48) and experimental (n = 48) groups. The control group received standard of care only, while the experimental group received twelve-weeks of the RAE program and standard of care. The instruments used were the demographic and health history data questionnaire, a modified Thai version of the self-care of diabetes index (SCODI), a self-care evaluation instrument to prevent diabetic foot (ISPDF) ailments, the Thai visual analogue scale foot and ankle (TH VAS-FA), and Foot Health Status Assessment Form (FHSF). Data was analyzed by descriptive statistics, Chi-squared test, independent t-test, one-way repeated measure multivariate analysis of variance (MANOVA), and post-hoc test.Results demonstrated that the RAE program effectively influenced self-care behavior, and foot self-care behavior in the experimental group when measured over time. The mean scores for the SC1, SC2, SC3, SC4, FSC1, FSC2, and FSC3 in persons with type 2 diabetes mellitus who participated in the RAE program were statistically and significantly better than those who received routine care only and before starting the program when measured over time at weeks 8 and 12 (p < 0.001, p < 0.001). There were significant differences in mean scores for foot health status when measured over time at baseline and week 12 (p < 0.001). The mean scores for the FH and FC in persons with type 2 diabetes mellitus who received the RAE program were statistically and significantly better than those who received routine care only and before starting the program when measured over time between baseline and week 12 (p < 0.001). However, no statistically significant escalation in DFU severity was reported among persons with T2DM participating in the RAE program compared with those in the control group who only received routine nursing care. Regarding the dimension of developing moderate to high risk of DFU, persons with type 2 DM in both groups had foot health status without increasing first-ever DFU risks. Integrating this RAE program may potentially improve the ability of persons with type 2 diabetes mellitus to perform self-care behavior and improve foot health status. Additionally, the program may simplify development of the ability to maintain health, monitor foot symptoms, management, and sustain self-care behavior, and lower the risk of developing foot ulcers. However, no significant differences were found in escalation of DFU severity between the RAE and routine care groups. Both groups maintained similar risk profiles for first-ever DFUs according to the IWGDF guidelines. Nurses and health care professionals can incorporate this program into standard nursing care to improve adherence and encourage proper self-care practices. The program can support patients in maintaining their self-care and foot health while minimizing the risks of diabetic foot ulcers and amputations.