Knowledge, Attitude, Practice and Associated Factors Related to Diabetic Foot Ulcer among Nurses: A Systematic Review

Background: Diabetic foot ulcers (DFUs) are among the most severe complications of diabetes mellitus, contributing to high morbidity, mortality, and healthcare costs globally. DFU prevalence around the world was estimated at 6.3%, with prevalence in Asia at 5.5%. Nurses play a pivotal role in DFU care and prevention. However, their knowledge, attitudes, and practices (KAP) vary widely across settings. This systematic review aims to synthesise evidence regarding the level of KAP and associated factors among nurses in managing DFUs. Methods: A systematic search was conducted using Scopus, ScienceDirect, and Google Scholar for studies published between 2014 and April 2024. The search followed PRISMA 2020 guidelines. Inclusion criteria included observational and interventional studies focusing on nurse-related KAP on DFU management. Exclusion criteria included systematic review, meta-analyses, conference abstracts, editorials, theses, or book chapters. Quality was appraised using the Joanna Briggs Institute (JBI) checklist. Results: This review found that, of the 6,932 studies initially screened, only 30 met the predefined inclusion criteria. The majority employed cross-sectional designs, with sample sizes ranging from 8 to 4,011 participants. Although several studies demonstrated moderate to high levels of knowledge among respondents, notable deficiencies were identified, particularly in practice and formal DFU training. Knowledge was positively associated with education, recent training, and working environment. However, attitude and practice did not always correlate with expertise. Barriers included excessive workload, limited resources, and restricted access to continuing education. Conclusion: There is wide variability in nurses’ KAP on DFU care, influenced by sociodemographic, institutional, and professional factors. Structured, standardized and comprehensive DFU training framework and integration of DFU care into continuing nursing education is essential to improve patient outcomes.