The overall certainty of evidence for educational programme effects on nurses' knowledge and practice is very low (GRADE), driven by bias, inconsistency and imprecision¶

Claim · All claims
Evidence · 1 study · review r3 · q3
Currency · newest study 2026 · not yet checked against its sources · not reviewed by a person

Subclaims¶

q3 i? Risk of bias, inconsistency and imprecision were each judged serious; indirectness was not serious; overall certainty was rated very low for both outcomes. → Al‐Me'ani Mohammad 2026

Evidence¶

Al‐Me'ani Mohammad 2026¶

Al‐Me'ani Mohammad, Alqaisi Omar, Dibas Mohammed, Al‐Aaraj Heyam, Rubbai Yousef. (2026). Effectiveness of Educational Programmes on Knowledge and Practice Related to Diabetic Foot Care Among Nurses: A Systematic Review. Endocrinology, Diabetes & Metabolism. https://doi.org/10.1002/edm2.70324

q3 · i? · review · r3

The review's own GRADE assessment across nine studies (589 participants for knowledge, 436 for practice, per Table 4), rating overall certainty 'very low' for both outcomes; the review states the true effect may differ substantially from reported estimates.

"the risk of bias was judged to be serious; all nine included studies utilized quasi‐experimental designs, predominantly lacking randomization and concurrent control groups, which significantly restricts causal inference"

Discussion¶

Related Claims¶

• Educational programmes are consistently associated with statistically significant improvements in nurses' knowledge of diabetic foot care across nine quasi-experimental studies, with very low certainty of evidence — a narrower finding that bears on this claim
• Educational programmes are associated with significant improvements in nurses' diabetic foot care practice, measured in seven of the nine included studies — related
• The evidence base on inclusion effects is methodologically weak: no randomised studies and nearly all synthesised studies at serious risk of bias — related
• An interactive workshop produced higher post-test knowledge scores than an e-learning course of equivalent content among nurses — related
• Most included studies carried a high risk of bias or some concerns, particularly for confounding and outcome measurement, limiting certainty — related
• No included randomized comparison was at low risk of bias, and all 17 non-randomized comparisons were rated serious risk under ROBINS-I — related
• Nurses begin with low baseline knowledge of diabetic foot care, and educational qualifications may moderate post-training knowledge gains — a narrower finding that bears on this claim
• Certainty of evidence for all outcomes was rated low due to serious risk of bias and heterogeneity — related
• Certainty of evidence for narrative medicine education effects is rated very low under GRADE — related
• Included active-methodology studies had a high overall risk of bias — related
• Risk-of-bias assessment finds 76% of included RCTs at low risk of bias using the Cochrane RoB-2 tool — related
• All twelve included studies carried at least moderate risk of bias, with none rated low on at least six criteria — related
• Only two studies evaluated learning outcomes, with small improvements and very low to moderate certainty — related
• Methodological quality of included studies is generally low, with only one RCT rated high quality — related