Effect of Digital Intervention on Nurses’ Knowledge About Diabetic Foot Ulcer: A Quasi-Experimental Study

Gustavo de Carvalho, Kauan; Nogueira, Lídya Tolstenko; Rocha, Daniel de Macêdo; Lira, Jefferson Abraão Caetano; Rocha, Álvaro Sepúlveda Carvalho; Bezerra, Sandra Marina Gonçalves; Nogueira, Luciana Tolstenko; Vasconcelos, Claudia Daniella Avelino; Ramos, Iara Barbosa; Sousa, Laelson Rochelle Milanês

doi:10.3390/ijerph22111610

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Effect of Digital Intervention on Nurses’ Knowledge About Diabetic Foot Ulcer: A Quasi-Experimental Study

by

Kauan Gustavo de Carvalho

¹

,

Lídya Tolstenko Nogueira

¹,

Daniel de Macêdo Rocha

^2,*

,

Jefferson Abraão Caetano Lira

¹

,

Álvaro Sepúlveda Carvalho Rocha

¹,

Sandra Marina Gonçalves Bezerra

³,

Luciana Tolstenko Nogueira

⁴

,

Claudia Daniella Avelino Vasconcelos

¹,

Iara Barbosa Ramos

²

and

Laelson Rochelle Milanês Sousa

⁵

¹

Department of Nursing, Federal University of Piauí, Teresina 64049-550, Brazil

²

Department of Nursing, Federal University of Mato Grosso do Sul, Coxim 79400-000, Brazil

³

Department of Nursing, State University of Piauí, Teresina 64049-550, Brazil

⁴

Department of Medicine, State University of Piauí, Teresina 64049-550, Brazil

⁵

Nursing Course, State University of Maranhão, Coroatá 65665-000, Brazil

^*

Author to whom correspondence should be addressed.

Int. J. Environ. Res. Public Health 2025, 22(11), 1610; https://doi.org/10.3390/ijerph22111610

Submission received: 12 August 2025 / Revised: 26 September 2025 / Accepted: 20 October 2025 / Published: 22 October 2025

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Abstract

Educational strategies based on technological models that integrate the dimensions of prevention, screening, and treatment of diabetic foot ulcers are emerging as promising methods to improve nurses’ knowledge, skills, and clinical competencies in primary care. In this investigation, we evaluated the effectiveness of a digital education program, mediated by a virtual learning environment, in enhancing nurses’ clinical knowledge about diabetic foot ulcers. This quasi-experimental intervention study was conducted with 114 nurses, selected for convenience, from the five health districts that make up primary care in the municipality of Teresina, Brazil. Two stages, separated by the educational intervention, allowed us to measure their knowledge levels before and after the implementation of the digital technology. A characterization form and the Nurse Knowledge Assessment Questionnaire on Diabetic Foot were used to evaluate the outcomes. The McNemar test compared the pre- and post-intervention knowledge levels, while accuracy rate-based parameters allowed for the classification of results into performance categories. The intervention effect size was estimated using Cohen’s d test. Results showed substantial improvements in knowledge, particularly in domains related to definition (p = 0.002), risk factors (p < 0.001), associated complications (p < 0.001), signs and symptoms of neuropathies (p < 0.001), application of tests to assess protective sensation (p < 0.001) and foot biomechanics (p < 0.001), risk classification (p < 0.001), and prevention strategies (p < 0.001), with performance ratings predominantly “good” or “excellent” after the intervention. The effect size for paired samples was large (Cohen’s dz = 1.82), based on the total knowledge scores. Findings support the effectiveness signal of the virtual learning environment for knowledge improvement; however, without a control group, we cannot rule out testing effects. Controlled or stepped-wedge trials should confirm causality.

Keywords: diabetic foot; nurse; knowledge; mainstreaming; education; primary health care

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MDPI and ACS Style

Gustavo de Carvalho, K.; Nogueira, L.T.; Rocha, D.d.M.; Lira, J.A.C.; Rocha, Á.S.C.; Bezerra, S.M.G.; Nogueira, L.T.; Vasconcelos, C.D.A.; Ramos, I.B.; Sousa, L.R.M. Effect of Digital Intervention on Nurses’ Knowledge About Diabetic Foot Ulcer: A Quasi-Experimental Study. Int. J. Environ. Res. Public Health 2025, 22, 1610. https://doi.org/10.3390/ijerph22111610

AMA Style

Gustavo de Carvalho K, Nogueira LT, Rocha DdM, Lira JAC, Rocha ÁSC, Bezerra SMG, Nogueira LT, Vasconcelos CDA, Ramos IB, Sousa LRM. Effect of Digital Intervention on Nurses’ Knowledge About Diabetic Foot Ulcer: A Quasi-Experimental Study. International Journal of Environmental Research and Public Health. 2025; 22(11):1610. https://doi.org/10.3390/ijerph22111610

Chicago/Turabian Style

Gustavo de Carvalho, Kauan, Lídya Tolstenko Nogueira, Daniel de Macêdo Rocha, Jefferson Abraão Caetano Lira, Álvaro Sepúlveda Carvalho Rocha, Sandra Marina Gonçalves Bezerra, Luciana Tolstenko Nogueira, Claudia Daniella Avelino Vasconcelos, Iara Barbosa Ramos, and Laelson Rochelle Milanês Sousa. 2025. "Effect of Digital Intervention on Nurses’ Knowledge About Diabetic Foot Ulcer: A Quasi-Experimental Study" International Journal of Environmental Research and Public Health 22, no. 11: 1610. https://doi.org/10.3390/ijerph22111610

APA Style

Gustavo de Carvalho, K., Nogueira, L. T., Rocha, D. d. M., Lira, J. A. C., Rocha, Á. S. C., Bezerra, S. M. G., Nogueira, L. T., Vasconcelos, C. D. A., Ramos, I. B., & Sousa, L. R. M. (2025). Effect of Digital Intervention on Nurses’ Knowledge About Diabetic Foot Ulcer: A Quasi-Experimental Study. International Journal of Environmental Research and Public Health, 22(11), 1610. https://doi.org/10.3390/ijerph22111610

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Effect of Digital Intervention on Nurses’ Knowledge About Diabetic Foot Ulcer: A Quasi-Experimental Study

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