Lakhasly

2.Sample size,Sampling method :The participants of the study were diabetic patients recruited from the outpatient departments (OPD) of the Diabetic/Endocrinology Centers at Al-Mana Hospital (Al-Khobar and Dammam, Al-Aziziah) in the Eastern Region of Saudi Arabia.Using the Raosoft calculator, the minimum sample size was determined based on the total adult population in the Eastern Region of approximately 4,900,000, considering the prevalence rate of diabetes mellitus of 17.7% (International Diabetes Federation, 2022) and previous Saudi studies reporting knowledge of foot care of 55.1% (Alkalash et al., 2024; Aljaouni et al., 2024).A non-probability convenience sampling method was used, allowing the recruitment of readily accessible participants from the OPDs of the selected hospitals.The tool was available in both English and Arabic and consisted of four parts: Part I - Demographic Characteristics of Diabetic Adults: Includes age, gender, nationality, education level, and occupation.2- Follow up in the hospital (OPD) in Al-mana Hospital (Al-Khobar & Dammam, Alaziziah) 3- Patient with type 1&2 of DM. 4- Patient with diabetic foot or severe condition.Part II - Medical Profile of Diabetic Adults: Covers chronic illnesses, diabetes history, smoking habits, current medications, and the presence of foot ulcers.Part III - Foot Care Knowledge: Assesses understanding of foot ulcers, circulation, sensory issues, and the importance of foot examinations.Methods and Materials 2.1 Research Design This study utilized a non-experimental descriptive, cross-sectional design.Population: adult diabetic patients , Both males and female,All races and ethnicities ?2.3 Data Collection Tools The data collection tool was a validated questionnaire adopted from a previous study by Alkalash et al. (2024).Inclusion/exclusion criteria Inclusion Criteria 1- Adult patients Female & male 18 years old and above.Exclusion Criteria 1- Non-diabetic patients.Correct answers were scored as "1, " while incorrect and "I don't know/Sometimes" responses were scored as "0.2.2 Sample and Sampling Method ?With an alpha error of 0.05 and a confidence level of 95%, the estimated sample size was 384.3- Pregnant woman, Gestational diabetes.Responses are "Yes, " "No, " or "I don't know.Responses are "Yes, " "No, " or "Sometimes.?

2. Methods and Materials
   2.1 Research Design
   This study utilized a non-experimental descriptive, cross-sectional design.
   2.2 Sample and Sampling Method
   ●
   Population: adult diabetic patients , Both males and female,All races and ethnicities
   ●
   Sample size,Sampling method :The participants of the study were diabetic patients recruited
   from the outpatient departments (OPD) of the Diabetic/Endocrinology Centers at Al-Mana
   Hospital (Al-Khobar and Dammam, Al-Aziziah) in the Eastern Region of Saudi Arabia. A
   non-probability convenience sampling method was used, allowing the recruitment of readily
   accessible participants from the OPDs of the selected hospitals. Using the Raosoft calculator, the
   minimum sample size was determined based on the total adult population in the Eastern Region
   of approximately 4,900,000, considering the prevalence rate of diabetes mellitus of 17.7%
   (International Diabetes Federation, 2022) and previous Saudi studies reporting knowledge of foot
   care of 55.1% (Alkalash et al., 2024; Aljaouni et al., 2024). With an alpha error of 0.05 and a
   confidence level of 95%, the estimated sample size was 384.
   ●
   Inclusion/exclusion criteria
   Inclusion Criteria
   1- Adult patients Female & male 18 years old and above.
   2- Follow up in the hospital (OPD) in Al-mana Hospital (Al-Khobar &
   Dammam, Alaziziah)
   3- Patient with type 1&2 of DM.
   4- Patient with diabetic foot or severe condition.
   Exclusion Criteria
   1- Non-diabetic patients.
   2- A patient younger than 18 years old.
   3- Pregnant woman, Gestational diabetes.
   2.3 Data Collection Tools
   The data collection tool was a validated questionnaire adopted from a previous study by Alkalash et al.
   (2024). The tool was available in both English and Arabic and consisted of four parts:
   Part I – Demographic Characteristics of Diabetic Adults: Includes age, gender, nationality, education
   level, and occupation.
   Part II – Medical Profile of Diabetic Adults: Covers chronic illnesses, diabetes history, smoking habits,
   current medications, and the presence of foot ulcers.
   Part III – Foot Care Knowledge: Assesses understanding of foot ulcers, circulation, sensory issues, and
   the importance of foot examinations. Responses are “Yes,
   ” “No,
   ” or “I don’t know.
   ”
   Part IV – Foot Care Practices: Evaluates daily foot care routines, including nail care, shoe choice, and
   washing habits. Responses are “Yes,
   ” “No,
   ” or “Sometimes.
   ”
   Alkalash et al. (2024) pilot tested the questionnaire among 38 patients and content validation was done
   by experts for clarity and relevance. Cronbach’s alpha measured the reliability of the questionnaire, and
   obtained 0.86 for stated knowledge and 0.88 for foot care practice
   2.4 Procedures
   Data were collected using a barcode-linked Google Form at selected hospital clinics. Participants were
   provided with a brief introduction to the study and accessed the questionnaire via the barcode. Data
   collection was conducted from October to December 2025.
   2.5 Data Analysis
   Data analysis was performed using IBM SPSS version 22. Descriptive statistics, including frequency and
   percentage, were used to present socio-demographic and medical profiles. For foot care knowledge and
   practice, total scores were calculated by summing all items (13 questions for knowledge and 16 questions
   for practice). Correct answers were scored as “1,
   ” while incorrect and “I don’t know/Sometimes”
   responses were scored as “0.
   ” A cut-off point of 80% was used, where scores above 80% indicated good
   knowledge and practice, and scores below 80% indicated inadequate levels. The relationship between
   socio-demographic variables and knowledge and practice was analyzed using the chi-square test. A
   p-value of less than 0.05 was considered statistically significant.
   2.6 Ethical Considerations
   Prior to the commencement of data collection, Ethical approval was obtained from the Institutional
   Review Board (IRB) of Mohammed Al-Mana College for Medical Sciences (MACHS) as well as from
   the IRB of Al-Mana General Hospital (AGH) (Approval No.: SR/RP/229, dated September 30, 2025).
   The study protocol was fully explained to all participants, and written informed consent was obtained
   prior to participation. Participants were assured that their involvement was entirely voluntary and that
   they had the right to withdraw from the study at any time without any consequences. All collected data
   were kept anonymous and coded to ensure confidentiality. No identifying information, such as
   participants’ names, was included in any reports or publications. The data were stored securely and
   handled with strict confidentiality, and records were maintained for one year in accordance with
   institutional policies. No incentives were provided to participants for their involvement in the study.