Development and psychometric testing of the diabetic foot ulcer health belief scale

Background: Foot ulcers are a common complication of diabetes, and amputation is a frequent outcome in patients with diabetic foot ulcers (DFU) due to the diabetic-impaired wound healing process. Preventing and promptly treating DFU is thus of primary importance. An instrument is necessary to effectively assess the DFU health beliefs and related behaviors of diabetic patients. Purpose: The authors developed a new diabetic foot ulcer health belief scale (DFUHBS) and tested its psychometric properties. Methods: We recruited 277 diabetic patients with peripheral sensory neuropathy between March and October 2010. Participants completed DFUHBS interviews and the foot-care subscale of the summary of diabetes self-care activity (SDSCA) questionnaire. The DFUHBS comprised the three subscales of perceived threats, perceived benefits, and perceived barriers. Results: Principle components analysis supported the validity of the 3-factor structure. The three DFUHBS subscale scores correlated with SDSCA foot-care subscale scores. Foot ulcer admission history had a significant effect on participant DFUHBS subscale scores. The DFUHBS subscales had good internal consistency, inter-rater reliability, and test-retest reliability over a 2-week period. Conclusions / Implications for Practice: This study provides evidence for the validity and reliability of the three DFUHBS subscales. Clinicians may use this scale to survey the health beliefs of diabetic patients with regard to DFU and DFU preventive behaviors.