Cognitive gaps and educational needs in foot self-care among patients with diabetic foot from a health literacy perspective: A qualitative study

Objective

From both the healthcare provider and patient perspectives, this study explores the specific cognitive gaps and educational needs related to health literacy in the self-care behaviors of patients with Wagner grade 0 diabetic foot (DF), to provide a basis for optimizing intervention strategies.

Method

This study adopted a descriptive phenomenological qualitative research design. Based on the International Working Group on the Diabetic Foot (IWGDF) guidelines for foot ulcer prevention, we constructed a guideline for proper foot self-care behaviors. We conducted semi-structured interviews based on this guideline with 13 healthcare professionals with varying levels of clinical experience and 6 patients with Wagner grade 0 diabetic foot (DF). The data were analyzed using Colaizzi's 7-step method to extract the core themes.

Results

We extracted three core themes: (1) Deficits in Knowledge and Risk Perception (fragmented understanding of foot pathology, impaired causal reasoning); (2) Limitations in Self-care Ability and Social Support (physical limitations, inadequate social support); (3) Failures in the Communication and Information Environment (lack of terminology comprehension, unmet needs and inaccessible resources, spread of misinformation and desensitization to risks).

Conclusion

The self-care difficulties of Wagner stage 0 DF patients stem from a multi-dimensional deficit in health literacy: a disconnect between risk perception and the understanding of the behavioral cause-and-effect chain at the cognitive level, behavioral capabilities restricted by both physical and social factors, a communication gap due to a lack of terminology and resource discontinuity, and the vicious cycle of misinformation and risk insensitivity. This study moves beyond the previous focus solely on 'knowledge deficiency,' proposing the key roles of 'causal health literacy deficiency' and 'systemic ecological dysfunction.' It calls for a paradigm shift in health literacy education from imparting 'fragmented knowledge' to fostering 'causal internalization,' and from emphasizing 'individual responsibility' to enabling 'systemic empowerment,' providing a basis for the precise design of educational strategies centered on 'causal logic and system support.'