Validation of a new measure of protective footcare behaviour: the Nottingham Assessment of Functional Footcare (NAFF)

Abstract There are no measures available to document footcare practice among people with diabetes and yet such measures are needed as a surrogate marker in studies designed to determine the effectiveness of footcare education. We have therefore developed such a measure, the Nottingham Assessment of Functional Footcare (NAFF), and have assessed its reliability and validity. A pilot questionnaire was distributed to people with diabetes and healthy controls, before being revised and shortened. The revised version was assessed for internal consistency and reliability. The pilot 51‐item questionnaire was determined in 100 out‐patients with diabetes and 61 healthy controls. The internal consistency was 0.46 in people with diabetes and 0.39 in healthy volunteers. Twenty‐eight items showed significant differences between those with and without diabetes. The internal consistency and test–retest reliability of a revised version were determined in people with diabetes. The measure was further refined to a 29‐item version, which had an internal consistency of 0.53. There was a significant correlation (rs 0.83; p<0.001) and no significant difference (p = 0.85) between scores in the test–retest study. Respondents with neuropathy scored significantly higher than those without (p<0.01). We conclude that the NAFF could act as an outcome measure in the prospective trials which are needed to establish the place of education programmes in clinical practice. The measure could also be used in routine care to identify those whose usual foot care might put their feet at risk of future ulceration. Copyright © 2007 John Wiley & Sons.