Analysis on the current status of foot self - management and influencing factors of high - risk diabetic foot patients based on COM-B model

Investigate the current status of foot self-management in high-risk diabetic foot patients, and explore the influencing factors of foot self-management behavior based on the COM-B model. A total of 394 high-risk diabetic foot patients who met the inclusion and exclusion criteria in the inpatient department of endocrinology at a tertiary hospital in Shanghai were selected as the research subjects using the convenience sampling method. The survey was conducted using a general information questionnaire, the Chinese version of the Nottingham foot care Assessment Scale, the Diabetes Health Literacy Scale, the Diabetic Foot Self-efficacy Scale, and the Chronic Illness Resource Utilization Survey Scale. The average score of foot self-management behavior among high-risk diabetic foot patients was 39.29±13.07. Multiple linear regression analysis identified influencing factors including age, education level, smoking status, history of diabetes health education, diabetes health literacy, foot self-efficacy, and chronic disease resource utilization. Structural equation modeling analysis revealed that diabetes health literacy and utilization of chronic illness resources not only have a direct positive impact on foot self-management behavior in high-risk diabetic foot patients but also exert an indirect positive influence through foot self-efficacy. The foot self-management ability of high-risk diabetic foot patients is at a medium level and needs to be improved. In the future, the Foot Self-management Ability of high-risk diabetic foot patients can be improved by enhancing their health literacy and utilization of chronic disease resources. • 1.Innovation in Theoretical Framework Construction • This study innovatively introduces the COM-B behavior change model into the research field of foot self-management behaviors in high-risk diabetic foot patients. This model provides an integrated theoretical framework for systematically analyzing the influencing factors of patient behavior, compensating for the limitations of traditional single-factor analyses, and contributing to a deeper understanding of the complex motivations and barriers behind behaviors. • 2.Innovation in Research Perspective and Topic Selection • Unlike previous studies that focused on a single dimension, this research, based on the COM-B model, comprehensively examines the combined influence of patients' capability, opportunity, and motivation—the three core dimensions—on their foot self-management behaviors. This approach offers a new perspective for a more comprehensive and systematic exploration of the factors influencing behaviors in this population. • 3Innovation in Research Methodology and Approach • Methodologically, this study employs structural equation modeling for exploratory analysis. By constructing and validating a hypothetical model, it not only quantitatively assesses the direct effects of capability, opportunity, and motivation on behaviors but also preliminarily reveals the potential interactions among these factors and their complex pathways influencing behavior. This deepens the methodological understanding of the mechanisms underlying behavior change.