{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T06:48:21Z","timestamp":1791182901054,"version":"4.1.0"},"reference-count":40,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"This study was financed in part by the Universidade Federal de Mato Grosso do Sul- Brasil","award":["Finance Code 001"],"award-info":[{"award-number":["Finance Code 001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Educational strategies based on technological models that integrate the dimensions of prevention, screening, and treatment of diabetic foot ulcers are emerging as promising methods to improve nurses\u2019 knowledge, skills, and clinical competencies in primary care. In this investigation, we evaluated the effectiveness of a digital education program, mediated by a virtual learning environment, in enhancing nurses\u2019 clinical knowledge about diabetic foot ulcers. This quasi-experimental intervention study was conducted with 114 nurses, selected for convenience, from the five health districts that make up primary care in the municipality of Teresina, Brazil. Two stages, separated by the educational intervention, allowed us to measure their knowledge levels before and after the implementation of the digital technology. A characterization form and the Nurse Knowledge Assessment Questionnaire on Diabetic Foot were used to evaluate the outcomes. The McNemar test compared the pre- and post-intervention knowledge levels, while accuracy rate-based parameters allowed for the classification of results into performance categories. The intervention effect size was estimated using Cohen\u2019s d test. Results showed substantial improvements in knowledge, particularly in domains related to definition (p = 0.002), risk factors (p &lt; 0.001), associated complications (p &lt; 0.001), signs and symptoms of neuropathies (p &lt; 0.001), application of tests to assess protective sensation (p &lt; 0.001) and foot biomechanics (p &lt; 0.001), risk classification (p &lt; 0.001), and prevention strategies (p &lt; 0.001), with performance ratings predominantly \u201cgood\u201d or \u201cexcellent\u201d after the intervention. The effect size for paired samples was large (Cohen\u2019s dz = 1.82), based on the total knowledge scores. Findings support the effectiveness signal of the virtual learning environment for knowledge improvement; however, without a control group, we cannot rule out testing effects. Controlled or stepped-wedge trials should confirm causality.<\/jats:p>","DOI":"10.3390\/ijerph22111610","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T01:14:02Z","timestamp":1761182042000},"page":"1610","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of Digital Intervention on Nurses\u2019 Knowledge About Diabetic Foot Ulcer: A Quasi-Experimental Study"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9940-1837","authenticated-orcid":false,"given":"Kauan","family":"Gustavo de Carvalho","sequence":"first","affiliation":[{"name":"Department of Nursing, Federal University of Piau\u00ed, Teresina 64049-550, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u00eddya Tolstenko","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Department of Nursing, Federal University of Piau\u00ed, Teresina 64049-550, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1709-2143","authenticated-orcid":false,"given":"Daniel de Mac\u00eado","family":"Rocha","sequence":"additional","affiliation":[{"name":"Department of Nursing, Federal University of Mato Grosso do Sul, Coxim 79400-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7582-4157","authenticated-orcid":false,"given":"Jefferson Abra\u00e3o Caetano","family":"Lira","sequence":"additional","affiliation":[{"name":"Department of Nursing, Federal University of Piau\u00ed, Teresina 64049-550, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1lvaro Sep\u00falveda Carvalho","family":"Rocha","sequence":"additional","affiliation":[{"name":"Department of Nursing, Federal University of Piau\u00ed, Teresina 64049-550, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra Marina Gon\u00e7alves","family":"Bezerra","sequence":"additional","affiliation":[{"name":"Department of Nursing, State University of Piau\u00ed, Teresina 64049-550, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2547-7545","authenticated-orcid":false,"given":"Luciana Tolstenko","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Department of Medicine, State University of Piau\u00ed, Teresina 64049-550, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Daniella Avelino","family":"Vasconcelos","sequence":"additional","affiliation":[{"name":"Department of Nursing, Federal University of Piau\u00ed, Teresina 64049-550, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1608-4336","authenticated-orcid":false,"given":"Iara Barbosa","family":"Ramos","sequence":"additional","affiliation":[{"name":"Department of Nursing, Federal University of Mato Grosso do Sul, Coxim 79400-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laelson Rochelle Milan\u00eas","family":"Sousa","sequence":"additional","affiliation":[{"name":"Nursing Course, State University of Maranh\u00e3o, Coroat\u00e1 65665-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1080\/07853890.2016.1231932","article-title":"Global epidemiology of diabetic foot ulceration: A systematic review and meta-analysis","volume":"49","author":"Zhang","year":"2017","journal-title":"Ann. 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