Gaps in nurse-led foot care education for people with type 2 diabetes: A cross-sectional survey of nurses

Introduction: Educating patients on safe foot care is a crucial component of preventing foot complications associated with type 2 diabetes. Nurses play a key role in providing preventive advice; however, the implementation of specific educational elements may be inconsistent. The aim of this study was to evaluate the content of foot care education provided by nurses to patients with type 2 diabetes in Almaty, identify the recommendations most frequently under-addressed, and examine sociodemographic and professional factors associated with the frequency of foot care education delivery.Materials and Methods: A cross-sectional study was conducted among nurses from municipal outpatient clinics across eight administrative districts of Almaty between April and November 2025. A total of 443 questionnaires were collected; after excluding 68 incomplete responses, data from 375 nurses were included in the final analysis. The frequency of implementation of 15 foot-care recommendations was assessed using the five-point DFCES-N scale. Responses of “never” and “rarely” were classified as infrequent provision. Descriptive statistics, Cronbach’s alpha, Spearman’s correlation, the Mann–Whitney U test, the Kruskal–Wallis test, and post-hoc comparisons with Holm correction were used.Results: The mean age of the participants was 40.48 ± 10.81 years, and women constituted 96.8% of the sample. The mean total DFCES-N score was 49.52 ± 22.20 out of a possible 75 (median: 55; IQR: 29–71), with a Cronbach’s alpha coefficient of 0.987. The proportion of infrequent provision across individual recommendations ranged from 31.7% to 45.9%. The highest proportions of infrequent provision were observed for the recommendations not to apply lotion between the toes (45.9%), to use moisturizing lotion on the feet (40.8%), and to trim toenails straight across (40.3%). Age, gender, and total nursing experience were not statistically significantly associated with the total DFCES-N score. Total DFCES-N scores differed across categories of experience in caring for patients with type 2 diabetes, although the effect size was small (H(4)=12.43; p=0.014; ε²=0.023). The breadth of general diabetes education positively correlated with the DFCES-N score (ρ=0.240; p<0.001).Conclusion: Nurses self-reported providing education on a broad range of general diabetes topics; however, specific practical aspects of foot care were implemented less consistently. The most significant gaps concerned the use of moisturizers, interdigital care, and nail care. The findings indicate a need to standardize the content of nursing education regarding patient foot care.