Summary: In a single-blind randomised trial in people with type 2 diabetes living in Karachi slums, a pictorial foot-care education intervention improved foot-care knowledge and practice scores substantially more than standard care.
PICO Summary
| Element | Detail |
|---|---|
| Population | 180 randomised (160 completed) adults with type 2 diabetes in slum areas of Karachi, Pakistan; single-blind RCT. |
| Intervention | Pictorial infographic-based foot-care education (n=90). |
| Comparison | Standard care without pictorial materials (n=90). |
| Outcome | Repeated-measures ANOVA showed significant effects of group and time and a significant group-by-time interaction. At 3 months the intervention arm improved markedly more (mean difference 3.53; 95% CI 3.11–3.96) than control (mean difference 0.87; 95% CI 0.34–1.40), both p<0.001. |
Pictorial foot-care education
RCT · type 2 diabetes · 3 months
Pictorial foot-care education raised knowledge and practice scores far more than standard care over 3 months (mean change +3.53 vs +0.87). The trial measured behaviour scores, not ulcers or amputations.
Expert Commentary
This is a pragmatic, equity-minded trial that deserves appreciation for tackling foot care where the burden is heaviest and resources are thinnest. The design is sound for its question, randomised with single blinding and an appropriate repeated-measures analysis, and the significant group-by-time interaction with a clearly larger improvement in the intervention arm is a credible signal that simple pictorial education can lift foot-care knowledge and self-care behaviour in a low-literacy, underserved setting. The intervention is cheap, scalable, and culturally adaptable, which is precisely what is needed where diabetic foot complications drive avoidable amputations and catastrophic costs. The honest limitation is the outcome itself: this trial measured knowledge and practice scores over three months, not hard endpoints such as ulceration, infection, or amputation, and knowledge gains do not always translate into sustained behaviour or fewer wounds. A single-clinic setting and short follow-up also temper generalisability. Can I use this with my patients? Yes, readily. It reinforces using clear visual foot-care education, especially for patients with limited literacy, as a low-risk component of diabetes care, while I stay realistic that education complements rather than replaces regular foot examination, risk stratification, and podiatric access.
References
Sharif H, Kadir M, Hashmi M, et al. Effectiveness of pictorial educational intervention on foot care among individuals having type 2 diabetes at slums of Karachi, Pakistan: a single blinded randomized control trial. BMC Public Health. 2025;25(1):3214. doi:10.1186/s12889-025-23969-6