Narrative review: results of the literature search on guidelines for self-care practices in the prevention of diabetic foot
To better organize the literature review and understand the content selected for the history of the cordel, a foot care checklist was created, including inspection, hygiene, use of appropriate footwear, and complementary diabetes treatment to prevent decompensation and the risk of diabetic foot.
After the narrative review, important information was selected and organized using index cards to guide the text of the material. The text took into account some unique characteristics of the target audience, with age group being one of the factors considered in the appropriateness of the language, illustrations, and formatting, given that approximately 90% to 95% of diabetes cases are type 2 diabetes mellitus (T2DM), and it is usually diagnosed after age 40(26).
Thus, the material was developed using language accessible to people with the disease, their families, and caregivers, regardless of social class. It also aims to be an attractive tool that sparks public interest through its content and illustrations, as it promotes stimulation, relaxation, excitement, and demonstrations of how care should be provided(27).
Table 2 below presents the list of content selected for the cordel.
Table 2 - General foot care for people with diabetes and described in the Cordel Educativo, Fortaleza-CE, Brazil, 2023
|
Types of foot care |
|
Inspection - Use a mirror or ask someone else to help you examine your feet.
- Check your legs and feet daily.
- Check for cuts, cracks, calluses, blisters, wounds, and infections.
- If you experience swelling, heat, redness, itching, pain, or any of the signs mentioned above, go to your nearest health center for evaluation by a healthcare professional.
- Observe the sensitivity of your feet.
Note: If you don't notice that the ground is hot or cold, or if you have calluses, cracks, blisters, or cuts, these may mean your feet are already numb. |
|
Hygiene - Wash your feet regularly. Use room-temperature water. Do not soak your feet or use hot water bottles, as this can cause burns.
- Dry your feet thoroughly with a soft towel, especially between your toes.
- Always keep your skin well moisturized. Use oils or moisturizers, except between your toes.
- Cut your nails straight across. Do not remove cuticles or the corners of your nails.
- Do not cut calluses or warts. |
|
Use of appropriate footwear - Always wear comfortable shoes, even at home.
- When wearing closed-toe shoes, always wear cotton or wool socks, seamless and elastic. Light-colored socks are preferred.
- Inspect and feel the inside of your shoes and socks before putting them on.
- At the end of the day, your feet will usually be more swollen, so buy shoes that aren't too tight. |
|
Complementary treatment of diabetes to prevent decompensation and the risk of diabetic foot · Maintain a healthy, balanced diet. · Exercise regularly. · Maintain healthy lifestyle habits (don't smoke and avoid drinking alcohol). · Control your blood sugar levels. · Take prescribed medications as directed.
|
Source: Research data (2023).
Cordel Educativo: initial version
Figure 1 - Illustration of the initial version of Cordel, Fortaleza, Ceará, Brazil, 2023
Source: Research data (2023).
Below is a description of all the
content listed in Table 3.
Table 3 - Content covered on each page of the Educational Cordel entitled “João's fight against the wound on his big toe: overcoming diabetic foot”, Fortaleza-CE, 2023
|
Part of the Cordel per page |
Content described |
|
Front and back covers – 1 and 2 |
Name of the author, title of the cordel and folkloric figures from the Northeast, cangaço man in traditional costume and foot injury. |
|
Technical sheet and presentation sheet – 3 and 4 |
Specifications for authorship, technical organization, graphic design, spelling, and editing. The presentation sheet details the objective of the work and states that it was a master's thesis. |
|
Stories and verses from cordel – 5 to 24. |
The beginning of a man's story with the outcomes and guidelines for foot care. |
Source: Prepared by the authors (2025).
Figure 2 – Final version of the Educational Cordel
Source: Prepared by the authors (2023).
Validation of the content and appearance of the cordel
Twenty-three judges participated in the study, all of whom were nurses. Of these, 43.5% (n=10) graduated between 2011 and 2020. Regarding postgraduate training, 95.7% (n=22) of the participants had completed specialization; the majority in the areas of Public Health, Family Health, and/or Collective Health, 54.6% (n=12); and they obtained their specialist title between 2011 and 2020, 68.2% (n=15). Furthermore, 47.8% (n=11) had a master's degree and 8.7% (n=2) had completed a doctorate. The majority worked in healthcare, 91.3% (n=21), with an equal division between primary care, 47.8% (n=11), and tertiary care, 43.5% (n=10). The average length of service was 48 months, ranging from 24 to 144 months (Table 1).
Table 1 – Educational profile of judges, Fortaleza, Ceará, Brazil, 2023
|
Variabçes |
N |
% |
|
Graduation year |
|
|
|
Before 2000 |
7 |
30,4 |
|
2000 to 2010 |
6 |
26,1 |
|
2011 to 2020 |
10 |
43,5 |
|
Especialization |
|
|
|
Yes |
22 |
95,7 |
|
No |
1 |
4,3 |
|
Especialization area |
|
|
|
Public/Family/Collective Health |
12 |
54,6 |
|
Education |
2 |
9,1 |
|
Others |
8 |
36,3 |
|
Year of Degree (Specialization) |
|
|
|
Before 2000 |
2 |
9,1 |
|
2000 to 2010 |
5 |
22,7 |
|
2011to 2020 |
15 |
68,2 |
|
Master's degree |
|
|
|
Yes |
11 |
47,8 |
|
No |
12 |
52,2 |
|
Year of degree (master's degree) |
|
|
|
2011 to 2020 |
6 |
54,6 |
|
2021 and on |
5 |
45,4 |
|
Doctorate |
|
|
|
Yes |
2 |
8,7 |
|
No |
21 |
91,3 |
|
Year of degree (doctorate) |
|
|
|
2011 to 2020 |
1 |
50,0 |
|
2021 and on |
1 |
50,0 |
|
Current ocuppation |
|
|
|
Assistance |
21 |
91,3 |
|
Teaching |
2 |
8,7 |
|
Institution which works |
|
|
|
Primary Attention |
11 |
47,8 |
|
Tertiary care |
10 |
43,5 |
|
Education |
2 |
8,7 |
|
Working time (months) |
|
|
|
Average ± DP* |
103 ± 108 |
|
|
Median (IIQ**) |
48 (24 – 144) |
|
SD: standard deviation; **IQR: interquartile range (25-75).
Source: Survey data (2022).
When assessing the CVI of the instrument's items, all items were considered validated, achieving CVI>0.80 and p>0.05. The "objective" domain had a CVI=1.00 (95% CI: 0.98–1.00) and p=0.166; the "structure and presentation" domain had a CVI=0.99 (95% CI: 0.96–1.00) and p=0.500. Finally, the "relevance" domain had a CVI=1.00 (95% CI: 0.97–1.00) and p=0.226.
When the binomial test was performed to identify inter-rater agreement, it was observed that, when an agreement level of 80% was established, all items met the agreed level for all responses. The instrument had a CVI=1.00 (95% CI: 0.99–1.00) and p=0.056 (Table 2).
Table 2 – Distribution of instrument items according to objective, structure, presentation, and relevance, Fortaleza, Ceará, Brazil, 2023
|
Items |
IVC |
IC95%* |
p-value** |
|
|
Inferior limit |
Superior limit |
|||
|
Objective |
1,00 |
0,98 |
1,00 |
0,116 |
|
Addresses the topic effectively |
1,00 |
0,85 |
1,00 |
0,089 |
|
Clarifies the importance of the topic |
1,00 |
0,85 |
1,00 |
0,089 |
|
There is clarity in the information |
1,00 |
0,85 |
1,00 |
0,089 |
|
Expresses ability to aggregate information |
1,00 |
0,85 |
1,00 |
0,089 |
|
Portrays important key aspects |
1,00 |
0,85 |
1,00 |
0,089 |
|
Correctly explains the purpose of the educational booklet (Cordel) |
1,00 |
0,85 |
1,00 |
0,089 |
|
Empowers individuals to promote health and change behavior and attitudes |
1,00 |
0,85 |
1,00 |
0,089 |
|
The information is consistent with the needs of individuals with diabetes or at-risk foot |
1,00 |
0,85 |
1,00 |
0,089 |
|
Reflects the main aspects of diabetic foot prevention |
1,00 |
0,85 |
1,00 |
0,089 |
|
The illustrations represent the theme in an understandable way |
1,00 |
0,85 |
1,00 |
0,089 |
|
Structure and presentation |
0,99 |
0,96 |
1,00 |
0,500 |
|
The information is scientifically correct |
1,00 |
0,85 |
1,00 |
0,089 |
|
The language is clear and objective with understandable terms |
1,00 |
0,85 |
1,00 |
0,089 |
|
The text size and number of screens are adequate |
0,96 |
0,78 |
1,00 |
0,315 |
|
The content follows a logical sequence and is well structured regarding grammar and spelling. |
1,00 |
0,85 |
1,00 |
0,089 |
|
The material is appropriate for the sociocultural level of the individuals |
1,00 |
0,85 |
1,00 |
0,089 |
|
The illustrations are expressive and sufficient |
1,00 |
0,85 |
1,00 |
0,089 |
|
Relevance |
1,00 |
0,97 |
1,00 |
0,226 |
|
Emphasizes the key aspect that should be reinforced |
1,00 |
0,85 |
1,00 |
0,089 |
|
The educational booklet (Cordel) proposes to individuals with diabetes that they acquire knowledge about the prevention of diabetic foot |
1,00 |
0,85 |
1,00 |
0,089 |
|
Clarifies to the public some issues related to the problem |
1,00 |
0,85 |
1,00 |
0,089 |
|
Encourages reflection on the subject |
1,00 |
0,85 |
1,00 |
0,089 |
|
Portrays the necessary aspects for the prevention of sexual violence |
1,00 |
0,85 |
1,00 |
0,089 |
|
It is suitable and can be used by any professional in educational activities. |
1,00 |
0,85 |
1,00 |
0,089 |
|
Complete instrument (S-CVI/Ave) |
1,00 |
0,99 |
1,00 |
0,056 |
* Binomial test; **95% CI: 95% confidence interval.
Source: Survey data (2022).
When evaluating the CVI of the SAM items, it was found that all were considered validated, as they obtained a CVI>0.80 and p>0.05. The "content" domain had a CVI=0.93 (95% CI: 0.84–0.98) and p=0.281; the "structure" domain had a CVI=0.99 (95% CI: 0.92–1.00) and p=0.141; the "graphic illustrations" domain totaled a CVI=0.91 (95% CI: 0.79–0.98); the "motivation" domain had a CVI=0.97 (95% CI: 0.90–1.00); and the "cultural suitability" domain had a CVI=0.98 (95% CI: 0.78–1.00) and p=0.315.
When the binomial test was performed to identify inter-rater agreement, it was observed that, when an agreement level of 80% was established, all items had agreement in at least 80% of responses. The entire instrument obtained a CVI of 0.96 and (95% CI: 0.93–0.98) p=0.350 (Table 3).
Table 3 – Validation of the SAM instrument by the judges, Fortaleza, Ceará, Brazil, 2023
|
Items |
IVC |
IC95%* |
p-valor** |
|
|
Limite inferior |
Limite superior |
|||
|
Content |
0,93 |
0,84 |
0,98 |
0,281 |
|
The objective is clear, facilitating the ready understanding of the material |
0,96 |
0,78 |
1,00 |
0,315 |
|
The content covers information regarding behaviors that help care for and prevent diabetic foot. |
0,91 |
0,72 |
0,99 |
0,592 |
|
The proposed material is limited to objectives, so that the viewer can reasonably understand it in the time allowed. |
0,91 |
0,72 |
0,99 |
0,592 |
|
Language |
0,99 |
0,92 |
1,00 |
0,141 |
|
The reading level is adequate for patient understanding |
0,96 |
0,78 |
1,00 |
0,315 |
|
The conversational style makes it easier to understand the text |
1,00 |
0,85 |
1,00 |
0,089 |
|
The vocabulary uses common words |
1,00 |
0,85 |
1,00 |
0,089 |
|
Graphic illustrations |
0,91 |
0,79 |
0,98 |
0,480 |
|
The cover attracts attention and portrays the purpose of the material |
0,91 |
0,72 |
0,99 |
0,592 |
|
Illustrations present key visual messages so the reader can grasp the main points on their own without distractions. |
0,91 |
0,72 |
0,99 |
0,592 |
|
Motivation |
0,97 |
0,90 |
1,00 |
0,300 |
|
There is interaction between the text and/or figures and the reader, leading them to solve problems, make choices and/or demonstrate skills |
1,00 |
0,85 |
1,00 |
0,089 |
|
Desired behavior patterns are modeled or well demonstrated |
0,96 |
0,78 |
1,00 |
0,315 |
|
There is motivation for self-efficacy, that is, people are motivated to learn because they believe that tasks and behaviors are feasible. |
0,96 |
0,78 |
1,00 |
0,315 |
|
Cultural suitability |
0,98 |
0,89 |
1,00 |
0,064 |
|
The material is culturally appropriate to the logic, language and experience of the target audience |
1,00 |
0,85 |
1,00 |
0,089 |
|
Presents culturally appropriate images and examples |
0,96 |
0,78 |
1,00 |
0,315 |
|
Complete instrument (S-CVI/Ave) |
0,96 |
0,93 |
0,98 |
0,350 |
*Binomial test; **95% CI: 95% confidence interval.
Source: Survey data (2022).
The technical judges validated all items of the cordel's objectives, and the CVI for this category was 0.95. Two judges suggested adding the importance of continuous multidisciplinary monitoring. Two other judges suggested changing the term "doctor" to refer to the physician, aiming to clarify each professional's category and roles within the healthcare team.
DISCUSSION
Among diabetes control measures, adherence to medication treatment, when necessary, as well as non-medication treatment, stands out. This includes a healthy diet, regular physical activity, and care that can be offered within primary health care by Family Health Strategy (ESF) teams. Although these are simple measures, in some cases, they are poorly followed by the general population and people with diabetes, detrimental to the need for lifestyle changes, which is a complex issue(28).
One of the main benefits of cordel literature is that it brings the population closer to knowledge on various topics, including diabetic foot care. It should value the cultural aspects of the target audience to foster knowledge acquisition and, thus, adopt healthy habits, enabling healthcare professionals to use it to encourage proactive behavior and improve quality of life(29).
It can be observed that the profile of the specialists, most of whom work in primary care, contributes to better content validation, as these professionals have insight and experience with patients with diabetes. All 20 judges were nurses and held postgraduate degrees in areas related to nursing care or teaching, regarding patient care in primary care.
This profile of judges is similar to that found in a study conducted in Piauí, which aimed to develop and validate the content and appearance of a flipchart on diabetic foot prevention for use by primary care professionals(18). This study involved seven specialists, with a predominance of nurses with a master's degree (85.7%) and between 5 and 30 years of training (71.4%). All of the judges had experience in teaching, specifically health education, and worked directly with patients with diabetic foot. Six (85.7%) experts presented published research in the area of diabetes mellitus and instrument validation.
The profile of the judges in this study also reflects that of a study conducted in Recife, which aimed to validate an educational technology in the form of a cordel with nursing guidelines on cardiac surgery. The initial sample consisted of 11 judges, including nurses, physicians, and educators with more than three years of experience in surgical nursing, cardiac surgery, teaching, educational technology, and/or cordel literature. The judges also presented scientific literature in the field and experience in instrument validation(30).
A study that aimed to describe the validation of a booklet on foot self-care for people with diabetes and conducted with the participation of 11 nurse judges identified a total CVI of 0.99(31). The number of judges was smaller than in the present study; however, the CVI found was equivalent to that of the research in this article.
The cordel, titled "João's fight against the wound on his big toe: overcoming diabetic foot," reached its final form, containing 24 pages, including the cover, all with educational illustrations that aid in learning about care.
The literature review guided the development of the technology, with the following topics listed:
● General guidelines for users with diabetes.
● Treatment adherence.
● Technologies for self-care for diabetics.
These topics served as the basis for the cordel's content.
The content presented in the technology provided easy-to-understand language, a conversational style that facilitates understanding, and vocabulary using common words.
The images were created by a graphic designer hired to create the cordel, who followed the described guidelines. The images chosen are appropriate for reader comprehension and are placed on the pages of their respective explanations.
Regarding formatting, large fonts were used for the text and titles. Regarding diabetic foot care, small, objective texts were chosen to facilitate reader comprehension.
Regarding the judges' evaluation of the cordel, these were of paramount importance in achieving the final result. Some suggestions were accepted for modifications to the content, language, and layout.
The technical judges validated all items of the cordel's objectives, and the CVI for this category was 0.95. Two judges suggested adding the importance of ongoing multidisciplinary monitoring. Two other judges suggested changing the term “doctor” to refer to physician, aiming to clarify the category of each professional and clarify the functions within the health team.
Study limitations
The limitations of this study include the lack of clinical validation of the technology with the target audience and the lack of validation of the audio version of the cordel among judges and people with diabetes. Therefore, future studies recommend validating the written cordel among diabetic patients, as well as adapting and validating the cordel among people with hearing (audiocordel) and visual (Libras) impairments.
Contributions to the area
Nurses play a key role in welcoming patients with diabetes, providing care ranging from health education to developing initial care. Nursing care for people with diabetes is based on developing autonomy in the patient or caregiver, in addition to encouraging lifestyle changes, reducing signs and symptoms of the disease, preventing acute and chronic complications, and promoting an improvement in overall quality of life(32).
Healthcare professionals can use educational technologies to mediate the educational process, fostering interaction between the educator/healthcare professional and the student/user. These educational technologies facilitate more interactive learning and facilitate health promotion actions, enabling the development of knowledge(18,33).
It is important to emphasize that, in communities, the role of the nurse is directly linked to health promotion. Therefore, the cordel created is strongly recommended, as it aims to promote health guidance. It is expected to be a useful technology that contributes to the expansion of knowledge about the prevention of diabetic foot complications.
CONCLUSIONS
The cordel literature developed and validated in this study can be considered to have good reliability and trustworthiness, as it obtained a CVI above 0.90 for all items (content, language, graphic illustrations, motivation, and cultural appropriateness), as well as a total CVI of 0.96. The judges' evaluation confirmed this result, demonstrating that the technology is innovative, uses easy-to-understand language, and is relevant for assisting patients with diabetes.
Thus, it is believed that the cordel literature can be safely used by nurses during individual consultations and in collective educational activities with patients with diabetes, enabling the prevention and care of diabetic foot in a playful and inclusive manner. This reaffirms the importance of using cordel literature in healthcare practices and educational activities, facilitating better communication between professionals and patients, promoting the strengthening of self-care for diabetic foot.
FINANCIAL SUPPORT
Article without funding.
REFERENCES
1. Malta DC, Andrade SSCA, Oliveira TP, Moura L, Prado RR, Souza MFM. Probability of premature death for chronic non-communicable diseases, Brazil and Regions, projections to 2025. Rev Bras Epidemiol [Internet]. 2019 [citado 2025 Jun 17];22:1-13. Disponível em: https://www.scielo.br/j/rbepid/a/r7QkT4hR3HmkWrBwZc6bshG/?lang=en doi: https://doi.org/10.1590/1980-549720190030
2. World Health Organization. Adherence to long-term therapies: evidence for action [Internet]. Geneva: World Health Organization; 2020 [citado 2022 Jun 15]. Disponível em: https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf?sequence=1&isAllowed=y
3. International Diabetes Federation. IDF diabetes atlas [Internet] 9th ed. Brussels: International Diabetes Federation; 2019 [citado 2025 Jun 17]. Disponível em: https://www.diabetesatlas.org
4. Sacco ICN, Lucovéis MLS, Thuler SR, Parisi MCR. Diagnóstico e prevenção de úlceras no pé diabético. In: Sociedade Brasileira de Diabetes. Diretrizes da Sociedade Brasileira de Diabetes 2024 [Internet]. São Paulo: SBD; 2022 [citado 2025 Jun 4]. Disponível em: https://diretriz.diabetes.org.br/diagnostico-e-prevencao-de-ulceras-no-pe-diabetico/
5. International Diabetes Federation. IDF diabetes atlas [Internet]. Brussels: International Diabetes Federation; 2021 [citado 2022 Jun 2]. Disponível em: https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf
6. Martins AKL, Nunes JM, Nóbrega MFB, Pinheiro PNC, Souza AMA, Vieira NFC, et al. Literatura de cordel: tecnologia de educação para a saúde e enfermagem. Rev Enferm [Internet]. 2011 [citado 2022 Jun 27];19(2):324-29. Disponível em: http://www.revenf.bvs.br/pdf/reuerj/v19n2/v19n2a25.pdf
7. Aquino PS, Melo RP, Lopes MVO, Pinheiro AKB. Análise do conceito de tecnologia na enfermagem segundo o método evolucionário. Acta Paul Enferm [Internet]. 2010 [citado 2025 Jun 17];23(5):690-96. Disponível em: https://www.scielo.br/j/ape/a/sq36ZSdYrgRmsS5vbhhPnNx/?lang=pt doi: https://doi.org/10.1590/S0103-21002010000500017
8. Conselho Nacional de Saúde (BR). Resolução nº 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos [Internet]. Brasília: CNS; 2012 [citado 2022 Ago 27]. Disponível em: https://conselho.saude.gov.br/resolucoes/2012/Reso466.pdf.
9. Polit DF, Beck CT. Delineamento de pesquisa em enfermagem: fundamentos de pesquisa em enfermagem: avaliação de evidências para a prática da enfermagem. Porto Alegre: Artmed; 2019.
10. Rodrigues WC. Metodologia científica [Internet]. Paracambi: FAETEC; 2007 [citado 2022 Ago 2]. Disponível em: https://www.hugoribeiro.com.br/biblioteca-digital/Rodrigues_metodologia_cientifica.pdf.
11. Mata AER, Silva FPS, Boaventura EM. Design-based research ou pesquisa de desenvolvimento: metodologia para pesquisa aplicada de inovação em educação do século XXI. Rev FAEEBA - Ed e Contemp [Internet]. 2014 [citado 2022 Ago 15];23(42):23-36. Disponível em: http://educa.fcc.org.br/pdf/faeeba/v23n42/0104-7043-faeeba-23-42-00023.pdf
12. Pasquali L. Psicometria: teoria e aplicações. Brasília: Editora da UnB; 1997.
13. Lynn MR. Determination and quantification of content validity. Nurs [Internet]. 1986 [citado 2025 Jun 18];35(6):382-85. Disponível em: https://journals.lww.com/nursingresearchonline/citation/1986/11000/determination_and_quantification_of_content.17.aspx doi: https://doi.org/10.1097/00006199-198611000-00017
14. Jasper MA. Expert: a discussion of the implications of the concept as used in nursing. J Adv Nurs [Internet]. 1994 [citado 2025 Jun 18];20(4):769-76. Disponível em: https://onlinelibrary.wiley.com/doi/epdf/10.1046/j.1365-2648.1994.20040769.x doi: https://doi.org/10.1046/j.1365-2648.1994.20040769.x
15. Teixeira E, Mota VMSS. Tecnologias educacionais em foco. São Caetano do Sul: Editora Difusão; 2011.
16. Doak CC, Doak LG, Root JH. Teaching patients with low literacy skills. Philadelphia: J.B. Lippincott; 1996. 129 p.
17. International Business Machines. IBM SPSS. Versão 23 [software]. 2023 [citado 2023 Fev 2]. Disponível em: https://www.ibm.com/br-pt/spss
18. Chaves MAA, Santos, RF, Moura LKB, Lago EC, Sousa KHJF, Almeida CAPL, et al. Elaboração e validação de um álbum seriado para prevenção do pé diabético. Rev Cuid [Internet]. 2021 [citado 2022 Jul 5];12(1):1-11. Disponível em: https://revistas.udes.edu.co/cuidarte/article/view/1233/2099 doi: https://doi.org/10.15649/cuidarte.1233
19. Souza IC, Costa JS, Alencar MMS, Monteiro PGA, Aquino PS, Castro RCMB. Construção e avaliação de álbum seriado para prevenção de complicações dos pés em diabéticos. Rev Rene [Internet]. 2021 [citado 2025 Jun 19];22:1-9. Disponível em: https://www.revenf.bvs.br/scielo.php?script=sci_arttext&pid=S151738522021000100320 doi: http://dx.doi.org/10.15253/2175-6783.20212261427
20. Menezes LGC, Guedes MVC, Oliveira SKP, Rocha RM, Pinheiro AKB, Silva LF, et al. Produção e validação do curta-metragem Pés que te quero®: tecnologia educacional para pessoas com diabetes. Rev Bras Enferm [Internet]. 2022 [citado 2025 Jun 19];75(5):1-8. Disponível em: https://www.scielo.br/j/reben/a/X3pFP7QBZN39YFhvXT5NdCN/?format=pdf&lang=pt doi: https://doi.org/10.1590/0034-7167-2021-0329
21. Castilho WL, Chavaglia SRR, Ohl RIB, Gamba MA, Freitas MAO. Módulo educativo em ambiente virtual de aprendizagem em diabetes mellitus. Enferm Glob [Internet]. 2020 Jul [citado 2025 Jun 17];59:360-74. Disponível em: https://revistas.um.es/eglobal/article/view/320631/284251 doi: https://doi.org/10.6018/eglobal.320631
22. Vêscovi SJB, Primo CC, Sant’ Anna HC, Bringuete MEO, Rohr RV, Prado TN, et al. Aplicativo móvel para avaliação dos pés de pessoas com diabetes mellitus. Acta Paul Enferm [Internet]. 2017 [citado 2025 Jun 17];30(6):607-13. Disponível em: https://www.scielo.br/j/ape/a/d9rKvFHtsrjqwyXgbjqvL5K/?lang=pt doi: http://dx.doi.org/10.1590/1982-0194201700087
23. Arruda C, Boell JEW, Silva DMGV, Lopes SGR, Lauterte P, Junkes C. Tecnologia educativa para cuidados e prevenção do pé diabético. Ciênc Cuid Saúde [Internet]. 2021 [citado 2025 Jun];20:1-8. Disponível em: http://www.periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/50115 doi: https://doi.org/10.4025/ciencuidsaude.v20i0.50115
24. Gomes LC, Moraes NM, Souza GFP, Brito FI, Antônio Júnior ME, Cipriano AE, et al. Contribuições de um programa educativo na prevenção de lesões nos pés de pessoas com diabetes mellitus. J Health NPEPS [Internet]. 2021 Jan-June [citado 2025 Jun 17];6(1):62-86. Disponível em: https://periodicos.unemat.br/index.php/jhnpeps/article/view/5102/4183
25. Marques MB, Coutinho JFV, Martins MC, Lopes MVO, Maia JC, Silva MJ. Intervenção educativa para a promoção do autocuidado de idosos com diabetes mellitus. Rev Esc Enferm USP [Internet]. 2019 [citado 2025 Jun 19];53:1-8. Disponível em: https://www.scielo.br/j/reeusp/a/gs7Q8rTDjhL3CLsKPCQHnTj/ doi: https://doi.org/10.1590/S1980-220X2018026703517
26. Forti AC, Pires AC, Pittito BA, Gerchman F, Oliveira JEP, Zajdenverg L, et al., organizadores. Diretrizes Sociedade Brasileira de Diabetes 2019-2020 [Internet]. São Paulo: Sociedade Brasileira de Diabetes; 2020 [citado 2022 Jun 15]. Disponível em: https://portaldeboaspraticas.iff.fiocruz.br/wp-content/uploads/2021/08/Diretrizes-Sociedade-Brasileira-de-Diabetes-2019-20201.pdf
27. Echer IC. Elaboração de manuais de orientação para o cuidado em saúde. Rev Latino Am Enfermagem [Internet]. 2005 [citado 2025 Jun 18];13(5):754-57. Disponível em: https://www.scielo.br/j/rlae/a/6ZJ3s4DtMzZvSJn4JbpD3WB/?format=pdf&lang=pt
28. Santos AL, Marcon SS, Teston EF, Back IR, Lino IGT, Batista VC, et al. Adherence to the treatment of diabetes mellitus and relationship with assistance in primary care. Rev Min Enferm [Internet]. 2020 [citado 2025 Jun 18];24:1-10. Disponível em: https://periodicos.ufmg.br/index.php/reme/article/view/49973/40848 doi: https://doi.org/10.5935/1415-2762.20200008
29. Albuquerque GA, Rocha TA, Leite GMS, Caçula SG, Lopes MR, Araruna VHC. Educação em saúde e prevenção ao novo coronavírus por meio da literatura de cordel. Asas da Palavra [Internet]. 2020 [citado 2022 Ago 9];17(2):54-62. Disponível em: http://revistas.unama.br/index.php/asasdapalavra/article/view/2333/pdf# doi: https://doi.org/10.17648/asas.v17i2.2333
30. Souza TMG. Validação da literatura de cordel como tecnologia educacional nas orientações ao paciente para cirurgia cardíaca [trabalho de conclusão de curso]. Recife: Universidade Federal de Pernambuco; 2019. Website para o programa disponível em: https://repositorio.ufpe.br/bitstream/123456789/33853/1/SOUZA%2c%20Taynara%20Maria%20Gomes%20de.pdf.
31. Galdino YLS, Moreira TMM, Marques ADB, Silva FAA. Validation of a booklet on self-care with the diabetic foot. Rev Bras Enferm [Internet]. 2019 [citado 2025 Jun 18];72(3):817-24. Disponível em: https://www.scielo.br/j/reben/a/LPNP8DyP7cPH9np3Rk3S79K/?lang=en doi: https://doi.org/10.1590/0034-7167-2017-0900
32. Conselho Regional de Enfermagem do Ceará. Cuidado à saúde na atenção à hipertensão na Atenção Primária de Saúde (APS): protocolo de enfermagem [Internet]. Fortaleza: Conselho Regional de Enfermagem; 2020 [citado 2022 Ago 27]. Disponível em: http://www.coren-ce.org.br/wp-content/uploads/2020/12/PROTOCOLO-DIABETES-e-HIPERTENS%C3%83O.pdf
33. Ministério da Saúde (BR). Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Ciência e Tecnologia. Política Nacional de Gestão de Tecnologias em Saúde. Brasília-DF: Ministério da Saúde; 2010.
Funding and Acknowledgments:
No funding was obtained.
Authorship Criteria (Author Contributions)
Mariana Barros Alves Jacinto: Contributed substantially to editing, writing, and critical review;
Thais Milene Rocha: Contributed to the organization and creation of the instrument, as well as to data collection, analysis, interpretation, and writing;
Socorro Milena Rocha Vasconcelos: Contributed to the organization and creation of the instrument, as well as to data collection, analysis, interpretation, and writing;
Sarah Feitoza Souza: Contributed to the critical review and analysis of the instrument;
Mayenne Myrcea Quintino Pereira Valente: Contributed to the critical review and analysis of the instrument;
Danielle Teixeira Queiroz: Contributed to the organization and creation of the instrument, as well as to the critical review and analysis of the instrument;
Adriani Zaluski Izoton: Contributed substantially to editing, writing, and critical review, as well as to the translation of the text;
Lea Maria Moura Barroso: Contributed to the organization and creation of the instrument, as well as its critical review and analysis.
Declaration of Conflict of Interest
Nothing to declare.
Scientific Editor: Francisco Mayron Morais Soares. Orcid: https://orcid.org/0000-0001-7316-2519
Rev Enferm Atual In Derme 2025;99(3): e025094
Atribuição
CCBY