Effectiveness of a Structured Teaching Programme on Prevention Knowledge of Diabetic Peripheral Neuropathy among Diabetic Patients at SCB Medical College, Cuttack, Odisha

Sonali Pattanayak¹, Sathish Rajamani², Sangeeta Naik

¹Assistant Professor, School of Nursing – DRIEMS University, Cuttack. Odisha, India.

²Professor, School of Nursing DRIEMS University, Cuttack, Odisha, India.

³Assistant Professor, School of Nursing, DRIEMS University, Cuttack, Odisha, India.

*Corresponding Author Email: mhnsathish@gmail.com

ABSTRACT:

Background of the Study: Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus, often leading to pain, disability, and a higher risk of foot ulcers and amputations. Despite its serious consequences, many patients have limited knowledge about preventive measures. Patient education is therefore essential to reduce risks and improve quality of life. Structured teaching programs can play a vital role in bridging this gap by enhancing awareness and encouraging preventive practices. Objective: The study was conducted to evaluate the effectiveness of a structured teaching program on the knowledge of diabetic peripheral neuropathy and its prevention among diabetic patients. The specific objectives were to assess baseline knowledge, implement the teaching program, measure its impact on knowledge scores, and examine associations between knowledge improvement and selected demographic variables. Methodology: A pre-experimental one-group pre-test and post-test design was adopted, guided by the General System Theory of Ludwig von Bertalanffy (1968). The study was carried out at Capital Hospital, Bhubaneswar, and SCB MCH Hospital, Cuttack. Diabetic patients above 30 years of age were selected using purposive sampling. Data were collected through a structured self-administered questionnaire. Statistical analysis was performed using paired comparisons and chi-square tests to evaluate knowledge improvement and associations with demographic factors. Results: The findings revealed a significant increase in knowledge scores after the intervention. Post-test scores were markedly higher than pre-test scores, confirming the effectiveness of the structured teaching program. Associations were observed between post-test knowledge and demographic variables such as age (χ²=14.22), education (χ²=31.98), family history of diabetes mellitus (χ²=7.92), and marital status (χ²=4.71), all significant at p<0.05. Conclusion: The structured teaching program proved effective in improving patients’ knowledge about diabetic peripheral neuropathy and its prevention. Integrating such educational interventions into routine diabetic care can empower patients, promote preventive practices, and reduce complications.

KEYWORDS: Diabetic peripheral neuropathy, Diabetes mellitus, Patient education, Structured teaching program, Prevention, Knowledge improvement.

INTRODUCTION:

Health is a dynamic state characterized by the body's continuous adjustment and adaptation to stressors and environmental changes to maintain equilibrium. Wellness, fundamentally, is a deliberate choice to take responsibility for the quality of one's life. It commences with a conscious decision to cultivate a healthy lifestyle. Wellness represents a mindset, a predisposition to embrace a set of key principles across various life domains that contribute to high levels of well-being and life satisfaction.¹

The International Diabetes Federation reports that 382 million people worldwide are currently living with diabetes. Among them, 193 million individuals are diabetic but remain undiagnosed, which heightens the risk of complications associated with diabetes mellitus (DM). Hyperglycemia presents numerous challenges, potentially affecting the cardiovascular system, kidneys, eyes, and nerves. Patients with diabetes may experience complications either at the point of diagnosis or within a few years of inadequate glycemic control.²

Diabetic peripheral neuropathy (DPN) is a common problem for people with type 2 diabetes (T2DM). It greatly affects their health. DPN is a condition where nerves are damaged due to changes in metabolism and small blood vessels. This happens because of factors like heart disease risks and long-term high blood sugar levels.³ In 2000, the global prevalence of diabetes across all age groups was estimated at 2.8%, and it is expected to increase to 4.4% by 2030. The number of individuals with diabetes is anticipated to grow from 171 million in 2000 to 366 million in 2030. Men are more likely to have diabetes than women. Additionally, the incidence of diabetes mellitus among urban populations in developing nations is predicted to double between 2000 and 2030.⁴

Diabetic peripheral neuropathy presents significant risks to the cardiovascular system, eyes, kidneys, and peripheral nerves. This condition increases the likelihood of foot ulcers, affecting approximately 3% of the global population with diabetes. Among these individuals, 10-15% may experience diabetic foot complications during their lifetime, contributing to nearly half of all hospital admissions for diabetic patients. The interplay of microvascular and macrovascular complications, combined with neuropathy, impairs skin integrity and delays wound healing, facilitating the development of ulcers. Individuals with diabetes may not perceive minor foot injuries due to neuropathy, leading to sores from continuous friction. Bacterial infection of the skin and connective tissue can result in gangrene and septicemia. In advanced stages, amputation of the foot or leg may become necessary.⁵

Diabetic peripheral neuropathy education empowers people with diabetes by providing knowledge and tools for active involvement in management. This includes detailed information on diabetes, its complications, treatment, self-care skills, resources, positive attitudes, and self-monitoring. Compliance is crucial for effective management. Education programs help people understand the importance of these actions, enhancing motivation for self-management. Dietary management aims to maintain ideal body weight, euglycemia, a desirable lipid profile, prevent complications, and provide optimal nutrition during pregnancy and old age. Regular physical activity is essential for managing type 2 diabetes. Physicians should assess individuals when incorporating exercise programs, which should be personalized. Proper footwear is necessary. Diabetic peripheral neuropathy diagnosis is stressful, requiring a holistic approach including behavioral modification for a positive attitude and healthy lifestyle. A satisfactory treatment plan should focus on the person with diabetes, quality of life, coping skills, family support, and a healthy work environment. Support and counseling are vital at diagnosis and throughout life.⁶

Diabetes is a deadly and costly chronic disease. Researchers believe that treatment involving nutrition, exercise, pharmacologic therapy, and insulin can control blood glucose, hypertension, and lipids. Nurses must teach patients self-care management of diabetes in inpatient and outpatient settings, encompassing roles as caregivers, educators, role models, patient advocates, and health promoters. The researcher chose this topic to apply her knowledge to diabetics for managing diabetic peripheral neuropathy.

OBJECTIVES OF THE STUDY:

1. To identify the existing knowledge regarding the prevention of diabetic peripheral neuropathy among patients with diabetes mellitus.

2. To administer a structured teaching program on the prevention of diabetic peripheral neuropathy among patients with diabetes mellitus.

3. To evaluate the effectiveness of the structured teaching program in improving knowledge about the prevention of diabetic peripheral neuropathy among patients with diabetes mellitus.

4. To determine the significant difference between pretest and posttest knowledge scores regarding the prevention of diabetic peripheral neuropathy among patients with diabetes mellitus.

5. To examine the association between posttest knowledge levels and selected demographic variables.

METHODOLOGY:

This study utilised an evaluative research methodology using a pre-experimental one-group pre-test post-test design to evaluate the efficacy of a structured education program on enhancing knowledge related to the prevention of diabetic peripheral neuropathy among diabetic patients. The research was executed at SCB MCH, Cuttack, Odisha, involving diabetes patients over the age of 30. The target population consisted of hospitalised diabetics, whereas the accessible population included those present during the data collection period. A purposive sample method was employed to choose 60 participants who satisfied the inclusion criteria. The criteria for inclusion were diabetes patients over 30 years of age, accessible during data collection, proficient in Odia or English, and eager to participate. Patients who were critically ill or reluctant to participate were omitted.

The investigator created a systematic self-administered questionnaire and a checklist after looking at a lot of literature and expert advice. These were used to collect data. The instrument consisted of two sections: demographic characteristics and knowledge pertaining to the prevention of diabetic peripheral neuropathy. Experts in nursing and medicine made sure that the content was valid, and changes were made based on their ideas. The test-retest method was used to show that the test was reliable, and the Karl Pearson correlation coefficient value was 0.85, which means that it was quite reliable.

The study protocol comprised a pre-test evaluation, succeeded by a structured educational program aimed at the prevention of diabetic peripheral neuropathy, and subsequently a post-test after seven days utilising the same instrument. The lesson discussed what complications are, how common they are, what causes them, what signs and symptoms to look for, how to manage them, and how to avoid them. We used both descriptive and inferential statistics to analyse the data. We utilised frequency, percentage, mean, and standard deviation to describe the data. We used paired t-test and chi-square test to see how effective the data was and how it was related to demographic variables. Throughout the study, ethical approval, informed consent, confidentiality, and the opportunity to withdraw were all taken care of.

RESULTS AND INTERPRETATIONS:

This study's analysis and interpretation were based on data obtained using a structured multiple-choice questionnaire to test knowledge and a tick list cum questionnaire to assess diabetic peripheral neuropathy prevention among diabetes patients. Based on the study's purpose, the results were computed using descriptive and inferential statistics.

Table 1: Frequency and Percentage Distribution of Samples According to Socio-Demographic Variables n = 60

S. No	Demographic Variables	Category	Frequency (n)	Percentage (%)
1	Age (in years)	30 – 50	11	18.3
		51 – 60	27	45.0
		61 – 70	16	26.7
		Above 70	6	10.0
2	Sex	Male	15	25.0
2	Sex	Female	45	75.0
3	Education	Primary	23	38.3
		Higher Secondary	21	35.0
		Graduation	16	26.7
		Post Graduation	0	0.0
4	Occupation	Worker	11	18.3
		Business	5	8.3
		Housewife	29	48.3
		Retired	15	25.0
		Govt. Employee	0	0.0
5	Monthly Income (₹)	Below 3000	18	30.0
		3000 – 6000	11	18.3
		6000 – 10000	26	43.3
		Above 10000	5	8.3
6	Duration of Diabetes Mellitus (years)	0 – 6 months	28	46.7
		6 months – 1 year	18	30.0
		More than 1 year	14	23.3
7	Type of Diabetes Mellitus	Type I (Insulin Dependent)	22	36.7
7	Type of Diabetes Mellitus	Type II (Non-Insulin Dependent)	38	63.3
8	Personal Habits	Smoking	7	11.7
		Alcohol	3	5.0
		Tobacco Chewing	19	31.7
		No Unhealthy Habits	31	51.7
9	Previous Knowledge on Diabetes Mellitus	Yes	51	85.0
9	Previous Knowledge on Diabetes Mellitus	No	9	15.0
10	Marital Status	Single	8	13.3
10	Marital Status	Married	52	86.7

Table 1 indicates that the predominant age group of diabetic patients is 51–60 years (45%), succeeded by the 61–70 years group (26.7%). A significant majority of the participants were female (75%) and married (86.7%). Concerning education, the majority of participants had attained elementary level (38.3%) or higher school (35%).

Regarding occupation, around 48.3% of the participants were housewives, while 25% were retirees. The predominant group had a monthly household income ranging from ₹6000 to ₹10000 (43.3%).

Regarding the illness profile, the majority of patients had Type II Diabetes Mellitus (63.3%) and were diagnosed for less than six months (46.7%). Over fifty percent of the subjects indicated the absence of detrimental personal habits (51.7%). A significant proportion of patients (85%) possessed prior awareness of diabetes mellitus.

Figure - 1: Percentage Distribution of Samples According to Knowledge Levels Among Samples During Pre-Test and Post-Test

The figure - 1 shows that in the pre-test, out of 60 diabetic patients, 26 (43.3%) had inadequate knowledge, 34 (56.7%) had moderately adequate knowledge, and none of them had adequate knowledge. In the post-test, 36 (60%) diabetic patients had adequate knowledge, 24 (40%) had moderately adequate knowledge, and none had inadequate knowledge.

It can be inferred that the majority of diabetic patients gained adequate knowledge after the intervention, whereas none had adequate knowledge in the pre-test.

Table 2: Effectiveness of 1. structured teaching program in improving knowledge about the prevention of diabetic peripheral neuropathy among patients with diabetes mellitus. (n = 60)

S No

Variables

Mean

t value

p value

Pre-test

13.73

2.64

3.9

(df=59)

0.002*

Post-test

18.7

2.85

* Significant at p value < than 0.05

The mean knowledge score among individuals with diabetes mellitus prior to the intervention was 13.73 (standard deviation: 2.64). Following the intervention, the mean score increased to 18.7 (standard deviation: 2.85) (Table II). The paired t-test yielded a value of 3.9 with 59 degrees of freedom and a p value of 0.002, indicating a statistically significant difference in knowledge scores before and after the intervention at the 0.05 significance level. These findings suggest that the teaching program effectively enhanced patient knowledge regarding the prevention of diabetic peripheral neuropathy.

The bar graph shows how much better diabetic patients' knowledge scores got in six important areas after the educational intervention. There was a steady and big improvement in all areas from the pre-test to the post-test.

General Knowledge (64%) had the most correct answers on the pre-test, while Preventive Measures (50.6%) had the least. After the intervention, there were big changes in all areas. The Complication Awareness category had the highest post-test score (77.2%), followed by Dietary Measures and General Knowledge, which both had scores of 73%.

Preventive Measures saw the biggest improvement, going from 50.6% to 74.3%, which is a gain of 23.7 percentage points. There were also big improvements in Medical Management (from 53.4% to 73%, +19.6%), Dietary Measures (from 55.5% to 73.6%, +18.1%), and Signs and Symptoms (from 58% to 70%, +12%).

In general, the figure shows that the structured educational intervention worked very well to enhance diabetic patients' understanding of many parts of diabetes treatment. The biggest gains were in preventative measures and awareness of complications.

None of the socio-demographic variables were associated with the post-test level of knowledge among the samples in this study, hence the research hypothesis were rejected.

DISCUSSION:

This study found that a systematic education approach improved diabetic peripheral neuropathy prevention knowledge. The mean knowledge score improved from 13.73 (SD: 2.64) to 18.7 (SD: 2.85), with a paired t-test value of 3.9 (df=59, p=0.002). This significant increase in knowledge reinforces the growing evidence that patient education is essential to diabetes treatment.

Structured training matches diabetic patient education evidence. Current research shows that patient education empowers diabetics by providing the knowledge and resources needed for active disease management. This includes thorough information on diabetic complications, self-care, resource use, and positive health behaviours needed for self-management and adherence. This study confirms that structured educational programs improve patient understanding and self-management motivation. The diversity in knowledge domain improvement was notable in this study. Preventive measures improved the greatest, from 50.6% to 74.3% (a 23.7 percentage point increase), followed by Medical Management (19.6%) and Dietary Measures (18.1%). This distribution indicates that focused educational initiatives improve baseline knowledge in places where it was low, demonstrating their ability to address patient awareness gaps. Complication Awareness had the highest post-test score of 77.2%, showing successful internalisation of diabetic peripheral neuropathy's significant effects.

The comprehensive scope of the teaching program, which encompassed complications, their prevalence, causative factors, signs and symptoms, management strategies, and preventive measures, likely contributed to the widespread improvements observed across all knowledge domains.⁷ Diabetic peripheral neuropathy constitutes a significant clinical concern, with approximately 3% of the global diabetic population affected by foot ulcers, and 10–15% experiencing diabetic foot complications during their lifetime.⁸ This high prevalence underscores the imperative for preventive education, as compromised skin integrity and delayed wound healing—resulting from the interaction of microvascular and macrovascular complications—facilitate ulcer development. The structured intervention directly addressed these issues by equipping patients with essential preventive knowledge.⁹

The predominance of Type II Diabetes Mellitus within the study population (63.3%) reflects the global epidemiological trend of diabetes, which continues to increase in prevalence. Regular physical activity and appropriate management strategies are essential for individuals with Type 2 diabetes, and nursing education plays a pivotal role in facilitating self-care management in both inpatient and outpatient settings.¹⁰The intervention implemented in this study aligns with the nursing role as educator and patient advocate, thereby contributing to enhanced health literacy and improved quality of life among diabetic patients.¹¹

The pre-experimental one-group pre-test post-test design, grounded in Ludwig von Bertalanffy’s General System Theory (1968), provided a suitable framework for assessing the intervention’s effectiveness. Although the absence of a control group is a limitation, the substantial effect sizes observed suggest genuine benefits attributable to the intervention. The use of a structured, self-administered questionnaire with demonstrated reliability (Karl Pearson correlation coefficient: 0.85) ensured consistent and valid measurement of knowledge outcomes throughout the study.¹²

A critical factor contributing to the intervention’s success pertains to the timing and comprehensive nature of the educational content. Patients newly diagnosed with diabetes (46.7% had been diabetic for less than six months) may be particularly receptive to preventive education prior to the onset of neuropathic complications. Early intervention within the disease trajectory offers opportunities for behavioral modification and lifestyle adjustments that can substantially mitigate the incidence and severity of complications. This approach aligns with evidence advocating holistic strategies, including behavioral modification, quality of life considerations, and coping skill development, as essential components of diabetic care.¹³

The lack of significant associations between most demographic variables and knowledge improvement suggests that the teaching program’s effectiveness was relatively consistent across diverse patient populations. This finding is encouraging, indicating that structured educational interventions can benefit diabetic patients regardless of age, education level, or other demographic factors, although the noted associations warrant consideration when tailoring interventions.

CONCLUSION:

The study demonstrated that a structured teaching program significantly enhanced diabetic patients' knowledge about preventing diabetic peripheral neuropathy. Improvements across key areas such as preventive measures, medical management, and dietary modifications highlight the value of comprehensive patient education. Integrating such programs into routine diabetes care can effectively reduce complications, morbidity, and associated healthcare costs. Future research should assess the long-term retention of knowledge, behavioral changes, and clinical outcomes, as well as compare the effectiveness of different educational approaches across diverse populations.

CONFLICT OF INTEREST:

There is no conflict of interest

ACKNOWLEDGEMENT:

The researcher wishes to thank everyone who assisted him in completing this research.

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Received on 22.04.2026 Revised on 23.05.2026

Accepted on 17.06.2026 Published on 27.07.2026

Available online from August 01, 2026

Asian J. Nursing Education and Research. 2026;16(3):207-212.

DOI: 10.52711/2349-2996.2026.00042

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.