Effectiveness of Health Education Program Regarding Foot Self-care on Risk for Developing Foot Ulcer Among Patients with Diabetes

Marwa Mosaad Ali; Samah Elsayed Ghonem

doi:doi:10.11648/j.ajns.20190805.20

| Peer-Reviewed

Effectiveness of Health Education Program Regarding Foot Self-care on Risk for Developing Foot Ulcer Among Patients with Diabetes

Marwa Mosaad Ali, Samah Elsayed Ghonem

Published in American Journal of Nursing Science (Volume 8, Issue 5)

Received: 15 August 2019 Accepted: 4 September 2019 Published: 29 September 2019

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Background: Diabetic foot has been considered as a major health problem in adults, because of its high incidence in recent years. Self-care programs have a role in the early prevention of morbidity and mortality rate of the diabetic foot, promoting patients knowledge and self-care practices are a crucial need in this regard. Aim of the study: To evaluate the effectiveness of health education program regarding foot self-care on risk for developing foot ulcer among patients with diabetes Research design: A quasi-experimental research design was used to conduct the current study. Setting: The current study was conducted in diabetes unit and outpatient clinics, at Benha university hospital, during the period from the beginning of September 2018 to beginning of June 2019. Subjects: A purposive sample of 132 patients recruited according to the study formula based on the total number of patients who admitted to the study settings during 2017, were randomly assigned into 68 patients in control group and 64 patients in intervention group, using permuted randomization table. Tools of data collection: Four tools were utilized for data collection, Tool I- Structured interviewing questionnaire sheet, involved (part 3) Structured Knowledge questionnaire, Tool II- Self-care confidence scale, Tool III- Foot self-care behavior scale and Tool IV- Inlow’s 60-second Diabetic Foot Screen. Results: Showed that mean score regarding knowledge, foot self-care confidence and behavior among intervention group were significantly higher after implementing intervention than among control group with a lower incidence of complications as well as there was a highly significant association between knowledge and self-efficacy among the studied groups, moreover the risk of developing foot ulcer was significantly lower among intervention group compared to control group post program implementation. Conclusion: The effectiveness of self-care educational program was approved in improving patients’ knowledge, self-care confidence, behavior and in return lowering the risk of developing foot ulcer. Recommendation: Based on findings in this study, regular continuing self-care programs should be designed to enhance patients’ ability to care for their foot with an emphasis on the most important risk factors and appropriate management in a large population.

Published in	American Journal of Nursing Science (Volume 8, Issue 5)
DOI	10.11648/j.ajns.20190805.20
Page(s)	274-287
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Diabetic Patients, Foot Self-care, Foot Ulcer, Health Education

References

[1]	Abdelsalam, N., Bakry, H., Said, R., Hammad, M., Mohamed, A. and El Shabrawy, A. (2017): Effectiveness of Health Education Intervention on Foot Self-Care Practice among Diabetics at Zagazig University Hospitals. The Egyptian Journal of Community Medicine, 35 (4): 57-69.
[2]	Al-Aboudi, S., Hassali, A. and Shafie, A. (2016): Knowledge, Attitudes, and Quality of Life of Type 2 Diabetes Patients in Riyadh, Saudi Arabia. J Pharm Bioallied Sci, 8 (3): 195-202. doi: 10.4103/0975-7406.171683.
[3]	Al-Ghazaly G., Al-Ahwal, L. and Zagloul, K. (2015): Risk Factors of Diabetic Foot Ulcer in Patients Attending Diabetic Foot Outpatient Clinic at Tanta University Hospital in Egypt. The Journal of Diabetic Foot Complications, 7 (2): 42-48.
[4]	American Diabetes Association (2015): The Standards of Medical Care in Diabetes. Diabetes Care; 38 (Suppl. 1): S1–S2. 2.
[5]	Armstrong D. G., Boulton A. J. M., Bus S. (2017): Diabetic Foot Ulcers and Their Recurrence. The New England Journal of Medicine; 376 (24): 2367–2375. doi: 10.1056/ NEJMra 161 5439.
[6]	Bays, H.; Chapman, R.; and Grandy, S. (2007): The Relationship of Body Mass Index to Diabetes Mellitus, Hypertension and Dyslipidaemia: Comparison of Data from Two National Surveys. Int J Clin Pract. 2007 May 1; 61 (5): 737–747. doi: 10.1111/j.1742-1241.2007.01336.x
[7]	Benha University Hospitals Statistical Office, (2017): statistical office Benha university Hospital Elkallubea, Egypt.
[8]	Bijoy, C., Feba, B., Vikas, R., Dhandapani, C., Geetha, K. and Vijayakumar, A. (2012): Knowledge Assessment and Patient Counseling on Diabetic Foot Care. Indian Journal of Pharmacy Practice, 5 (2): 11-15. Inlow S. A 60 second foot exam for people with diabetes. Wound Care Canada. 2004; 2 (2): 10-11. © CAWC 2011 101E.
[9]	Boulton, A Shaw, J (2016): The Pathogenesis Of Diabetic Foot Problems, An Overview, American diabetes Association, pub Med65 (9).
[10]	Chin, Y. F., & Huang, T. T. (2013). Development and Validation of a Diabetes Foot Self-Care Behavior Scale. The Journal of Nursing Research, 21 (1), 19–25.
[11]	Dorresteijn, J. A., Kriegsman, D. M, Assendelft, W. J. and Valk, G. D. (2014): Patient Education for Preventing Diabetic Foot Ulceration. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD001488. DOI: 10.1002/14651858. CD001488.pub5.www.cochranelibrary.comPatient education for preventing diabetic foot ulceration (Review) Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
[12]	El-Sedawy, D. and Behairy, A. (2016): Impact of Preventive Diabetic Foot Nursing Intervention on Foot Status among Patients with Diabetes. Journal of Health, Medicine and Nursing, 25 (1): 104-114. ISSN 2422-8419.
[13]	Fan, L., Sidani, S., Cooper-Brathwaite, A. and Metcalfe, K. (2014): Effects of a Foot Self-Care Educational Intervention on Improving Footwear Choices in Those with Type 2 Diabetes at Low Risk of Foot Ulceration. Diabetic Foot Canada Vol 2 No 2 2014.
[14]	Friedman, L. M., Furberg‏, C. D. and DeMets‏, D. L. (2010): Fundamentals of Clinical Trials: (Chapter 6) Randomization Process, (1st ed.). Springer Science+ Business Media: NY. pp. 100-101.
[15]	Fujiwara, Y., Kishida, K.., Terao, M., Takahara, M., Matsuhisa, M., Funahashi, T., Shimizu, Y. and Shimomura, I. (2011): Beneficial Effects of Foot Care Nursing for People with Diabetes Mellitus: An Uncontrolled before and after Intervention Study. Journal of Advanced Nursing 67 (9), 1952–1962.
[16]	Grillo, M., Neumann, C., Scain, S., Rozeno, R., Beloli, L., Perinetto, T., Gross, J. and LeitãZ, C. (2016): Diabetes Education in Primary Care: A Randomized Clinical Trial. Cad. SaúdePública 32 (5) 31 May2016 • https://doi.org/10.1590/0102-311X00097115.
[17]	Hindi, N., Chabuck, Z., Hindi, S. (2014): A review on role of Nurses in Diabetic Foot Ulcer Prevention and care. European Journal of Nursing. 2014; 1 (1): 22-26.
[18]	Inlow’S, A. (2004): 60 second foot exam for people with diabetes. Wound Care Canada.; 2 (2): 10-11.
[19]	International Diabetes Federation IDF. (2019): IDF Diabetes Atlas 8th edition 2017 global fact sheet. https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.Html.
[20]	Lavery, L. A., Peters, E. J., Williams, J. R., Murdoch, J. R., Hudson, A. and Lavery, D. C. (2008): Reevaluating the Way We Classify the Diabetic Foot. Restructuring the Diabetic Foot Risk Classifiation System of the International Working Group on the Diabetic Foot. Diabetes Care 31: 154–156.
[21]	Mokabel, F., Aboulazm, S., Hassan, H., Al-Qahtani, M., Alrashedi, S. and Zainuddin, F. (2017): The efficacy of a Diabetic Educational Program and Predictors of Compliance of Patients with Noninsulin-Dependent (type 2) Diabetes Mellitus in Al-Khobar, Saudi Arabia. J Family Community Med, 24 (3): 164–172. doi: 10.4103/jfcm.JFCM_45_16.
[22]	Moussa, M. and Gida, N. (2017): Effect of Foot Self-care Program among Diabetic Elderly Adults in Geriatrics Home. IOSR Journal of Nursing and Health Science (IOSR-JNHS). Volume 6, Issue 3 Ver. V (May - June 2017), PP 41-51.
[23]	Raghav, A., Khan, Z., Labala, R., Ahmad, J., Noor, S. and Mishra, B. (2018): Financial burden of diabetic foot ulcers to world: a progressive topic to discuss always. TherAdvEndocrinolMetab. 9 (1): 29–31. doi: 10.1177/2042018817744513.
[24]	Saleh, N., Shebl, A., Hatata E. and Refiei, M. (2012): Impact of Educational Program about Foot Care on Knowledge and Self-care Practice for Diabetic Older Adult. Journal of American Science; 8 (12). Available at http://www.jofamericanscience.org.
[25]	Seyyedrasooli, A., Parvan, K., Valizadeh, L., Rahmani, A., Zare, M. and Izadi, T. (2015): Self-Efficacy in Foot Care and Effect of Training: A Single-Blinded Randomized Controlled Clinical Trial. Int J Community Based Nurs Midwifery, 3 (2): 141-9.
[26]	Sharoni, S., Abdul Rahman, H., Minhat, H., Ghazali, S. and Ong, M. (2016): A self-Efficacy Education Programme on Foot Self-Care Behavior Among Older patients With Diabetes in A Public Long Term Care Institution, Malaysia: a Quasi experimental Pilot Study. BMJ Open 2017; 7: e014393. doi: 10.1136/bmjopen-2016-014393.
[27]	Sharoni, A., Abdul Rahman, H., Minhat, H., Shariff-Ghazali, S. and Ong, A. (2018): The Effects of Self-Efficacy Enhancing Program on Foot Self-Care Behaviour of Older Adults with Diabetes: A Randomised Controlled Trial in Elderly Care Facility, Peninsular Malaysia. PLoS ONE 13 (3): e0192417. https://doi.org/10.1371/journal.pone.0192417
[28]	Shaw, P. A., Johnson, L. L. and Borkowf, C. B. (2012): Principles and Practice of Clinical Research: (Chapter 20) Issues in Randomization, (3rd ed.). Ed (s). Gallin, J. I., & Ognibene‏, F. P. Elseveir Co.: USA, p. 246.
[29]	Sloan, H. L. (2002) Developing and testing of the foot care confidence scale. J Nurs Meas 10: 207-218.
[30]	Turns, M. (2013): "Diabetic foot ulcer management: the podiatrist's perspective". Br J Community Nurs. Suppl: S14, S16–9.
[31]	World Health Organization (WHO). )2019(: Diabetes Programme. Available @ https://www.who.int/diabetes/action_online/basics/en/index3.html. Accessed in 5 February, 2019. At 8:00 pm.
[32]	Yamane, T. (1967): Statistics an Introductory Analysis. 2nd Ed. New York Harper and Row CO. USA, 213.
[33]	Yusuf, S., Okuwa, M., Irwan, M., Rassa, S., Laitung, B., Thalib, A., Kasim, S., Sanada, H., Nakatani, T. and Sugama, J. (2016): Prevalence and Risk Factor of Diabetic Foot Ulcers in a Regional Hospital, EasternIndonesia. Open Journal of Nursing, 2016, 6, 1-10 Published Online January 2016 in Sci Res. http://www.scirp.org/journal/ojn. http://dx.doi.org/10.4236/ojn.2016.61001.
[34]	Yazdanpanah, L., Shahbazian, H., Nazari, I., Arti, H., Ahmadi, F., Mohammadianinejad, S. Cheraghian, B. and Hesam, S. (2018): Incidence and Risk Factors of Diabetic Foot Ulcer: A Population-Based Diabetic Foot Cohort (ADFC Study)—Two-Year Follow-Up Study. Int J Endocrinol. 2018; 7631659. Published online 2018 Mar 15. doi: 10.1155/2018/7631659.

Cite This Article

Plain Text BibTeX RIS

APA Style

Marwa Mosaad Ali, Samah Elsayed Ghonem. (2019). Effectiveness of Health Education Program Regarding Foot Self-care on Risk for Developing Foot Ulcer Among Patients with Diabetes. American Journal of Nursing Science, 8(5), 274-287. https://doi.org/10.11648/j.ajns.20190805.20

Copy | Download

ACS Style

Marwa Mosaad Ali; Samah Elsayed Ghonem. Effectiveness of Health Education Program Regarding Foot Self-care on Risk for Developing Foot Ulcer Among Patients with Diabetes. Am. J. Nurs. Sci. 2019, 8(5), 274-287. doi: 10.11648/j.ajns.20190805.20

Copy | Download

AMA Style

Marwa Mosaad Ali, Samah Elsayed Ghonem. Effectiveness of Health Education Program Regarding Foot Self-care on Risk for Developing Foot Ulcer Among Patients with Diabetes. Am J Nurs Sci. 2019;8(5):274-287. doi: 10.11648/j.ajns.20190805.20

Copy | Download

@article{10.11648/j.ajns.20190805.20,
  author = {Marwa Mosaad Ali and Samah Elsayed Ghonem},
  title = {Effectiveness of Health Education Program Regarding Foot Self-care on Risk for Developing Foot Ulcer Among Patients with Diabetes},
  journal = {American Journal of Nursing Science},
  volume = {8},
  number = {5},
  pages = {274-287},
  doi = {10.11648/j.ajns.20190805.20},
  url = {https://doi.org/10.11648/j.ajns.20190805.20},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajns.20190805.20},
  abstract = {Background: Diabetic foot has been considered as a major health problem in adults, because of its high incidence in recent years. Self-care programs have a role in the early prevention of morbidity and mortality rate of the diabetic foot, promoting patients knowledge and self-care practices are a crucial need in this regard. Aim of the study: To evaluate the effectiveness of health education program regarding foot self-care on risk for developing foot ulcer among patients with diabetes Research design: A quasi-experimental research design was used to conduct the current study. Setting: The current study was conducted in diabetes unit and outpatient clinics, at Benha university hospital, during the period from the beginning of September 2018 to beginning of June 2019. Subjects: A purposive sample of 132 patients recruited according to the study formula based on the total number of patients who admitted to the study settings during 2017, were randomly assigned into 68 patients in control group and 64 patients in intervention group, using permuted randomization table. Tools of data collection: Four tools were utilized for data collection, Tool I- Structured interviewing questionnaire sheet, involved (part 3) Structured Knowledge questionnaire, Tool II- Self-care confidence scale, Tool III- Foot self-care behavior scale and Tool IV- Inlow’s 60-second Diabetic Foot Screen. Results: Showed that mean score regarding knowledge, foot self-care confidence and behavior among intervention group were significantly higher after implementing intervention than among control group with a lower incidence of complications as well as there was a highly significant association between knowledge and self-efficacy among the studied groups, moreover the risk of developing foot ulcer was significantly lower among intervention group compared to control group post program implementation. Conclusion: The effectiveness of self-care educational program was approved in improving patients’ knowledge, self-care confidence, behavior and in return lowering the risk of developing foot ulcer. Recommendation: Based on findings in this study, regular continuing self-care programs should be designed to enhance patients’ ability to care for their foot with an emphasis on the most important risk factors and appropriate management in a large population.},
 year = {2019}
}

Copy | Download

TY  - JOUR
T1  - Effectiveness of Health Education Program Regarding Foot Self-care on Risk for Developing Foot Ulcer Among Patients with Diabetes
AU  - Marwa Mosaad Ali
AU  - Samah Elsayed Ghonem
Y1  - 2019/09/29
PY  - 2019
N1  - https://doi.org/10.11648/j.ajns.20190805.20
DO  - 10.11648/j.ajns.20190805.20
T2  - American Journal of Nursing Science
JF  - American Journal of Nursing Science
JO  - American Journal of Nursing Science
SP  - 274
EP  - 287
PB  - Science Publishing Group
SN  - 2328-5753
UR  - https://doi.org/10.11648/j.ajns.20190805.20
AB  - Background: Diabetic foot has been considered as a major health problem in adults, because of its high incidence in recent years. Self-care programs have a role in the early prevention of morbidity and mortality rate of the diabetic foot, promoting patients knowledge and self-care practices are a crucial need in this regard. Aim of the study: To evaluate the effectiveness of health education program regarding foot self-care on risk for developing foot ulcer among patients with diabetes Research design: A quasi-experimental research design was used to conduct the current study. Setting: The current study was conducted in diabetes unit and outpatient clinics, at Benha university hospital, during the period from the beginning of September 2018 to beginning of June 2019. Subjects: A purposive sample of 132 patients recruited according to the study formula based on the total number of patients who admitted to the study settings during 2017, were randomly assigned into 68 patients in control group and 64 patients in intervention group, using permuted randomization table. Tools of data collection: Four tools were utilized for data collection, Tool I- Structured interviewing questionnaire sheet, involved (part 3) Structured Knowledge questionnaire, Tool II- Self-care confidence scale, Tool III- Foot self-care behavior scale and Tool IV- Inlow’s 60-second Diabetic Foot Screen. Results: Showed that mean score regarding knowledge, foot self-care confidence and behavior among intervention group were significantly higher after implementing intervention than among control group with a lower incidence of complications as well as there was a highly significant association between knowledge and self-efficacy among the studied groups, moreover the risk of developing foot ulcer was significantly lower among intervention group compared to control group post program implementation. Conclusion: The effectiveness of self-care educational program was approved in improving patients’ knowledge, self-care confidence, behavior and in return lowering the risk of developing foot ulcer. Recommendation: Based on findings in this study, regular continuing self-care programs should be designed to enhance patients’ ability to care for their foot with an emphasis on the most important risk factors and appropriate management in a large population.
VL  - 8
IS  - 5
ER  -

Copy | Download

Author Information

Marwa Mosaad Ali

Medical-Surgical Nursing, Faculty of Nursing, Benha University, Benha, Egypt
Samah Elsayed Ghonem

Medical-Surgical Nursing, Faculty of Nursing, Benha University, Benha, Egypt

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Marwa Mosaad Ali, Samah Elsayed Ghonem. (2019). Effectiveness of Health Education Program Regarding Foot Self-care on Risk for Developing Foot Ulcer Among Patients with Diabetes. American Journal of Nursing Science, 8(5), 274-287. https://doi.org/10.11648/j.ajns.20190805.20

Copy | Download

ACS Style

Marwa Mosaad Ali; Samah Elsayed Ghonem. Effectiveness of Health Education Program Regarding Foot Self-care on Risk for Developing Foot Ulcer Among Patients with Diabetes. Am. J. Nurs. Sci. 2019, 8(5), 274-287. doi: 10.11648/j.ajns.20190805.20

Copy | Download

AMA Style

Marwa Mosaad Ali, Samah Elsayed Ghonem. Effectiveness of Health Education Program Regarding Foot Self-care on Risk for Developing Foot Ulcer Among Patients with Diabetes. Am J Nurs Sci. 2019;8(5):274-287. doi: 10.11648/j.ajns.20190805.20

Copy | Download

@article{10.11648/j.ajns.20190805.20,
  author = {Marwa Mosaad Ali and Samah Elsayed Ghonem},
  title = {Effectiveness of Health Education Program Regarding Foot Self-care on Risk for Developing Foot Ulcer Among Patients with Diabetes},
  journal = {American Journal of Nursing Science},
  volume = {8},
  number = {5},
  pages = {274-287},
  doi = {10.11648/j.ajns.20190805.20},
  url = {https://doi.org/10.11648/j.ajns.20190805.20},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajns.20190805.20},
  abstract = {Background: Diabetic foot has been considered as a major health problem in adults, because of its high incidence in recent years. Self-care programs have a role in the early prevention of morbidity and mortality rate of the diabetic foot, promoting patients knowledge and self-care practices are a crucial need in this regard. Aim of the study: To evaluate the effectiveness of health education program regarding foot self-care on risk for developing foot ulcer among patients with diabetes Research design: A quasi-experimental research design was used to conduct the current study. Setting: The current study was conducted in diabetes unit and outpatient clinics, at Benha university hospital, during the period from the beginning of September 2018 to beginning of June 2019. Subjects: A purposive sample of 132 patients recruited according to the study formula based on the total number of patients who admitted to the study settings during 2017, were randomly assigned into 68 patients in control group and 64 patients in intervention group, using permuted randomization table. Tools of data collection: Four tools were utilized for data collection, Tool I- Structured interviewing questionnaire sheet, involved (part 3) Structured Knowledge questionnaire, Tool II- Self-care confidence scale, Tool III- Foot self-care behavior scale and Tool IV- Inlow’s 60-second Diabetic Foot Screen. Results: Showed that mean score regarding knowledge, foot self-care confidence and behavior among intervention group were significantly higher after implementing intervention than among control group with a lower incidence of complications as well as there was a highly significant association between knowledge and self-efficacy among the studied groups, moreover the risk of developing foot ulcer was significantly lower among intervention group compared to control group post program implementation. Conclusion: The effectiveness of self-care educational program was approved in improving patients’ knowledge, self-care confidence, behavior and in return lowering the risk of developing foot ulcer. Recommendation: Based on findings in this study, regular continuing self-care programs should be designed to enhance patients’ ability to care for their foot with an emphasis on the most important risk factors and appropriate management in a large population.},
 year = {2019}
}

Copy | Download

TY  - JOUR
T1  - Effectiveness of Health Education Program Regarding Foot Self-care on Risk for Developing Foot Ulcer Among Patients with Diabetes
AU  - Marwa Mosaad Ali
AU  - Samah Elsayed Ghonem
Y1  - 2019/09/29
PY  - 2019
N1  - https://doi.org/10.11648/j.ajns.20190805.20
DO  - 10.11648/j.ajns.20190805.20
T2  - American Journal of Nursing Science
JF  - American Journal of Nursing Science
JO  - American Journal of Nursing Science
SP  - 274
EP  - 287
PB  - Science Publishing Group
SN  - 2328-5753
UR  - https://doi.org/10.11648/j.ajns.20190805.20
AB  - Background: Diabetic foot has been considered as a major health problem in adults, because of its high incidence in recent years. Self-care programs have a role in the early prevention of morbidity and mortality rate of the diabetic foot, promoting patients knowledge and self-care practices are a crucial need in this regard. Aim of the study: To evaluate the effectiveness of health education program regarding foot self-care on risk for developing foot ulcer among patients with diabetes Research design: A quasi-experimental research design was used to conduct the current study. Setting: The current study was conducted in diabetes unit and outpatient clinics, at Benha university hospital, during the period from the beginning of September 2018 to beginning of June 2019. Subjects: A purposive sample of 132 patients recruited according to the study formula based on the total number of patients who admitted to the study settings during 2017, were randomly assigned into 68 patients in control group and 64 patients in intervention group, using permuted randomization table. Tools of data collection: Four tools were utilized for data collection, Tool I- Structured interviewing questionnaire sheet, involved (part 3) Structured Knowledge questionnaire, Tool II- Self-care confidence scale, Tool III- Foot self-care behavior scale and Tool IV- Inlow’s 60-second Diabetic Foot Screen. Results: Showed that mean score regarding knowledge, foot self-care confidence and behavior among intervention group were significantly higher after implementing intervention than among control group with a lower incidence of complications as well as there was a highly significant association between knowledge and self-efficacy among the studied groups, moreover the risk of developing foot ulcer was significantly lower among intervention group compared to control group post program implementation. Conclusion: The effectiveness of self-care educational program was approved in improving patients’ knowledge, self-care confidence, behavior and in return lowering the risk of developing foot ulcer. Recommendation: Based on findings in this study, regular continuing self-care programs should be designed to enhance patients’ ability to care for their foot with an emphasis on the most important risk factors and appropriate management in a large population.
VL  - 8
IS  - 5
ER  -

Copy | Download