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Development and Validation of a Diabetes Foot Self-Care Behavior Scale

Chin, Yen-Fan1; Huang, Tzu-Ting2*

doi: 10.1097/jnr.0b013e3182828e59
Original Articles

Background: Foot self-care practice is one of the most important self-management behaviors to prevent the occurrence of diabetic foot ulcers. A tool that measures all aspects of daily foot care routines and demonstrates good reliability and validity is essential to pinpointing specific foot ulcer problems and evaluating intervention outcomes. There is currently no such tool available.

Purpose: This study developed a diabetes foot self-care behavior scale (DFSBS) and tested its psychometric properties.

Methods: The researchers reviewed the literature to generate the initial item pool. After expert confirmation of final draft scale content validity, we used convenience sampling to recruit 295 patients with diabetes and peripheral neuropathy who completed the scale. We analyzed results to determine the scale’’s psychometric properties, including construct validity, internal consistency, and test–retest reliability.

Results: The final scale consisted of a one-factor structure with seven items. The analysis of the scale indicated the DFSBS score as significantly correlated with the foot care subscale score of the Chinese version of the summary of diabetes self-care activity questionnaire (rho = .87, p < .001) and the Chinese version of the diabetes self-care scale (γ = .45, p < .001). Importantly, the DFSBS was found to differentiate between participants with and without a history of foot ulcers (Mann–Whitney Z = −3.09, p < .01). Internal consistency was acceptable (Cronbach’’s alpha = .73), and intraclass correlation coefficient for test–retest reliability over a 2-week period was .92.

Conclusion/Implications for Practice: This study provides evidence of the DFSBS validity and reliability. Clinicians may use the DFSBS to screen patients’’ foot self-care behavior, and researchers can use it to elucidate foot self-care issues.

1PhD Candidate, RN, Instructor, Graduate Institute of Clinical Medical Sciences, School of Nursing, Chang Gung University

2PhD, RN, Professor, Healthy Aging Research Center, and School of Nursing, Chang Gung University.

*Address correspondence to: Tzu-Ting Huang, No. 259, Wen-Hwa 1st Rd., Kwei-Shan Township, Taoyuan County 33302, Taiwan, ROC. Tel: +886 (3) 211-8800 ext. 5321; Fax: +886 (3) 211-8800 ext.5326; E-mail:

Accepted for publication: August 27, 2012

© 2013 Lippincott Williams & Wilkins, Inc.