Frontiers in public health · 2026
The relationship between digital health literacy, self-efficacy, and self-management behaviors in patients with diabetes-related foot disease: a cross-sectional study.
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Yao Jianxia, Huang Yongxin, Huang Jinqi, Yao Qiqi, Li Shuping, Wu Shanshan, Huang Aiqiong, Xie Baogen, Li Ruilin, Chen Qun, Cai Min
Аннотация
OBJECTIVE: This study aimed to explore the relationship among digital health literacy, self-efficacy, and self-management behaviors in patients with diabetes-related foot disease (DRFD), and to analyze the mediating role of self-efficacy.
METHODS: A cross-sectional survey was conducted from February 2024 to December 2025 among 328 patients with DRFD in a endocrinology department of tertiary hospital. Participants were recruited using a consecutive sampling method and completed a general information questionnaire, the eHealth Literacy Scale (eHEALS), the Diabetes Management Self-Efficacy Scale (DMSES), and the Diabetic Foot Self-Management Behavior Scale (DFSMBS). Mediation analysis was performed using the SPSS Process Macro (Model 4), with bootstrap resampling (5,000 iterations) to calculate 95% confidence intervals. The study was conducted in accordance with the STROBE guidelines.
RESULTS: Digital health literacy was moderately positively correlated with self-management behaviors (r = 0.42, p < 0.01). Self-efficacy was strongly positively correlated with self-management behaviors (r = 0.53, p < 0.01). These associations remained significant after controlling for potential confounding variables (including age, disease duration, and Wagner grade). Furthermore, self-efficacy partially mediated the relationship between digital health literacy and self-management behaviors, with a mediation effect of 0.23 [95% CI (0.156, 0.328)], accounting for 41.8% of the total effect.
CONCLUSION: Improving digital health literacy in patients with DRFD is directly associated with better self-management behaviors and is indirectly associated with them through increased self-efficacy. Clinical practice should integrate digital health education with psychological empowerment strategies to optimize self-management.
METHODS: A cross-sectional survey was conducted from February 2024 to December 2025 among 328 patients with DRFD in a endocrinology department of tertiary hospital. Participants were recruited using a consecutive sampling method and completed a general information questionnaire, the eHealth Literacy Scale (eHEALS), the Diabetes Management Self-Efficacy Scale (DMSES), and the Diabetic Foot Self-Management Behavior Scale (DFSMBS). Mediation analysis was performed using the SPSS Process Macro (Model 4), with bootstrap resampling (5,000 iterations) to calculate 95% confidence intervals. The study was conducted in accordance with the STROBE guidelines.
RESULTS: Digital health literacy was moderately positively correlated with self-management behaviors (r = 0.42, p < 0.01). Self-efficacy was strongly positively correlated with self-management behaviors (r = 0.53, p < 0.01). These associations remained significant after controlling for potential confounding variables (including age, disease duration, and Wagner grade). Furthermore, self-efficacy partially mediated the relationship between digital health literacy and self-management behaviors, with a mediation effect of 0.23 [95% CI (0.156, 0.328)], accounting for 41.8% of the total effect.
CONCLUSION: Improving digital health literacy in patients with DRFD is directly associated with better self-management behaviors and is indirectly associated with them through increased self-efficacy. Clinical practice should integrate digital health education with psychological empowerment strategies to optimize self-management.