Knowledge, attitude, and practice of foot care and associated factors among high-risk diabetic foot patients: A cross-sectional study in Shanghai, China.

OBJECTIVES: To investigate the current status of knowledge, attitude, and practice (KAP) regarding foot care among high-risk diabetic foot patients and to identify its associated factors. METHODS: A cross-sectional study was conducted from January 2025 to April 2026 in the Department of Endocrinology of a tertiary hospital in Shanghai, China. A total of 312 high-risk diabetic foot patients were recruited using convenience sampling. Data were collected using a general information questionnaire, the Diabetes Foot Care KAP Scale, the Social Support Rating Scale (SSRS), and the Diabetes Self-Efficacy Scale. Correlation analysis, univariate analysis, and multiple linear regression were performed to identify factors associated with KAP levels. RESULTS: The total KAP score was 37.70 (33.38-41.35), indicating a moderate level. Among the three dimensions, knowledge and attitude scores were relatively higher, while practice scores were the lowest. Multiple linear regression analysis showed that knowledge scores were associated with diabetes duration of 6-10 years (β = 0.136, P = 0.044) and insulin therapy (β = -0.157, P = 0.015). Attitude scores were associated with combination therapy (β = 0.192, P = 0.003), inadequate glycemic control (β = -0.146, P = 0.010), and self-efficacy (β = 0.154, P = 0.006). Practice scores were positively associated with female sex (β = 0.177, P = 0.001), adequate glycemic control (β = 0.221, P < 0.001), social support (β = 0.206, P < 0.001), and self-efficacy (β = 0.162, P = 0.002), whereas rural residence (β = -0.144, P = 0.005) and lack of diabetic foot education (β = -0.134, P = 0.009) were negatively associated with practice scores. The total KAP score was negatively associated with rural residence (β = -0.113, P = 0.035) and lack of diabetic foot education (β = -0.154, P = 0.010), but positively associated with combination therapy (β = 0.141, P = 0.026) and self-efficacy (β = 0.144, P = 0.009). CONCLUSION: High-risk diabetic foot patients demonstrated a moderate level of foot-care KAP, with a noticeable gap between knowledge and practice. Their KAP levels were influenced by multiple factors, including residence, marital status, glucose-lowering therapy, diabetes education, and self-efficacy. These findings suggest that integrated interventions focusing on structured health education, enhancement of self-efficacy, and improvement of healthcare accessibility are needed to improve foot-care KAP, thereby strengthening self-management and preventing diabetic foot complications.