Knowledge, attitudes and practices of nurses regarding diabetic foot ulcer care at Sunyani teaching hospital, Ghana: a cross-sectional study

Abstract

BACKGROUND: Diabetic foot ulcers (DFUs) are a major cause of morbidity, lower-limb amputation, and mortality among people with diabetes, particularly in low- and middle-income countries. Nurses play a key role in DFU prevention and management; however, evidence on their knowledge, attitudes, and practices (KAP) in Ghana remains limited. This study assessed nurses' KAP regarding DFU care at a tertiary hospital in Ghana. METHODS: A hospital-based cross-sectional study was conducted among nurses providing direct patient care from September to November 2025. A structured self-administered online questionnaire assessed socio-demographic characteristics and DFU-related knowledge, attitudes, and practices. Descriptive statistics summarized the data, and chi-square tests examined associations between knowledge levels and selected variables (p < 0.05). RESULTS: Of the 128 nurses invited, 100 participated (response rate: 78.1%). Most respondents were female (77%), and 90% had not received formal DFU training. Overall, 61% demonstrated good knowledge, 30% moderate knowledge, and 9% poor knowledge. Attitudes toward DFU care were generally positive, though workload constraints were noted. Common practices included patient education (81%), foot inspection (74%), and referral of suspected DFU cases (75%), while use of standardized neuropathy screening tools was low (10%) and documentation of foot-care education inconsistent (52%). Knowledge was significantly associated with academic qualification (χ² = 14.876, p = 0.002), years of practice (χ² = 8.219, p = 0.016), and prior DFU training (χ² = 12.604, p < 0.001). CONCLUSIONS: Despite positive attitudes toward DFU care, gaps remain in preventive knowledge and evidence-based screening practices. Strengthening structured DFU training and institutional support may improve nursing practice and patient outcomes.