Validation of a new measure of protective footcare behaviour: the Nottingham Assessment of Functional Footcare (NAFF)

Abstract

There are no measures available to document footcare practice among people with diabetes and yet such measures are needed as a surrogate marker in studies designed to determine the effectiveness of footcare education. We have therefore developed such a measure, the Nottingham Assessment of Functional Footcare (NAFF), and have assessed its reliability and validity. A pilot questionnaire was distributed to people with diabetes and healthy controls, before being revised and shortened. The revised version was assessed for internal consistency and reliability. The pilot 51‐item questionnaire was determined in 100 out‐patients with diabetes and 61 healthy controls. The internal consistency was 0.46 in people with diabetes and 0.39 in healthy volunteers. Twenty‐eight items showed significant differences between those with and without diabetes. The internal consistency and test–retest reliability of a revised version were determined in people with diabetes. The measure was further refined to a 29‐item version, which had an internal consistency of 0.53. There was a significant correlation (rs 0.83; p<0.001) and no significant difference (p = 0.85) between scores in the test–retest study. Respondents with neuropathy scored significantly higher than those without (p<0.01). We conclude that the NAFF could act as an outcome measure in the prospective trials which are needed to establish the place of education programmes in clinical practice. The measure could also be used in routine care to identify those whose usual foot care might put their feet at risk of future ulceration. Copyright © 2007 John Wiley & Sons.

Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial

“…It is also possible that the earlier study involved a patient population which had not previously had access to expert diabetes care and that the quality of education and support provided for those in the control group may have differed from the usual care available (almost 20 years later) for those attending specialist clinics in UK. Nevertheless, we noted that the NAFF scores achieved by both groups at 12 months in the present study (Table 3) were lower than those of the validation samples involved in the development of the NAFF [31], suggesting that the standard of protective foot care behaviour among our participants was not particularly good. Some caution should be attached to these observations because, although this was a randomised study and we had no reason to suspect a difference between groups, it is possible that these observations reflect chance differences between groups at baseline.…”

“…Some caution should be attached to these observations because, although this was a randomised study and we had no reason to suspect a difference between groups, it is possible that these observations reflect chance differences between groups at baseline. It should also be noted that the previously reported internal consistency of the NAFF was only just adequate [31], but there was no alternative measure available.…”

“…This assesses the effect of foot problems on aspects of daily life, such as leisure, physical health, daily activities, emotions, family, friends and satisfaction. Participants were also asked to complete the Nottingham Assessment of Functional Footcare (NAFF) questionnaire [31] at 12 months, by which the frequency of 29 foot care behaviours was assessed. This questionnaire was developed specifically to assess foot care behaviour for the study, as no previous measure was identified as being suitable.…”

Knowledge and Practice of Foot Care in Diabetic Inpatients: A Descriptive Cross-Sectional Study

“…The questionnaire developed by the researchers of this study was based on the Nottingham Assessment of Functional Footcare whose validity and reliability has been proven in the assessment of foot care practices, with some modifications to reflect cultural differences and was administered to patients through face-to-face interviews (14). The questions related to the sociodemographic information, history of diabetes, and DFU were included in the first part of the questionnaire and 20 questions related to footcare practices were included in the second part.…”

Effect of a Self-Management Support Program on Diabetic Foot Care Behaviors

“…This questionnaire was a modified version of the Nottingham Assessment of Functional Foot-care Questionnaire (NAFF) (Lincoln et al, 2007). The modified version of the questionnaire was translated into an Indonesian version using the back translation method.…”