Family Empowerment For Diabetic Foot Ulcer Prevention: A Six-Month Community Program
DOI:
https://doi.org/10.35568/abdimas.v9i1.7475Keywords:
Diabetic Foot Ulcer Prevention, Family-Centered Care, Health Literacy, Self-Management Education, Type 2 DiabetesAbstract
Diabetic foot ulcers (DFU) are a common and preventable complication of diabetes mellitus, often associated with low foot care literacy and limited family involvement in community settings in Indonesia. Objective: This study evaluated the effectiveness of a family-centered diabetic foot care education program in improving self-care behaviors, family engagement, health literacy, and quality of life among patients with type 2 diabetes. Methods: A six-month single-group pre–post community-based intervention was implemented at a semi-rural primary healthcare center in Tasikmalaya, Indonesia. Of 84 patient–family caregiver pairs recruited, 77 completed the program. The intervention included structured education, foot care demonstrations and redemonstration, family empowerment sessions, and regular home visits. Quantitative outcomes were measured using validated instruments, while qualitative data were collected through observations and family interviews. Results: Significant improvements were observed in family involvement, health literacy, dietary adherence, physical activity adherence, and quality of life (all p < 0.001). Blood glucose levels showed no significant change. Qualitative analysis identified three themes: increased awareness and confidence in foot care, strengthened family roles and shared responsibility, and perceived barriers to sustained glycemic control. Conclusion: Family-centered diabetic foot care education effectively strengthens self-care behaviors, family engagement, and psychosocial outcomes in community settings. Longer-term and integrated interventions may be required to improve metabolic outcomes.
Downloads
References
Aihemaiti, Y., Li, Z., Tong, Y., Ma, L., & Li, F. (2025). Influence of health literacy and self-management on quality of life among older adults with hypertension and diabetes in Northwest China. Experimental Gerontology, 206, 112776.
Amani, N., Nazari, A. M., Sanaie, N., Abbasi, A., & Borhani, F. (2025). Effects of family-centered empowerment program on illness acceptance and self-management of patients with type 2 diabetes: a randomized controlled trial. Scientific Reports, 15(1), 1–12. https://doi.org/10.1038/s41598-025-05833-0
American Diabetes Association. (2018). Good to Know: Factors Affecting Blood Glucose. Clin Diabetes, 1. https://doi.org/10.2337/cd18-0012
Astuti, R. K. (2024). Pengaruh Diabetes Self-Management Education (DSME) Berbasis Keluarga terhadap Peningkatan Pengetahuan dan Sikap dalam Pengendalian Glukosa Darah. Media Publikasi Promosi Kesehatan Indonesia (MPPKI), 7(2), 408–413. https://doi.org/10.56338/mppki.v7i2.4456
Bakhtiarvand, S. Z., Rahaei, Z., Sadeghian, H. A., Fatehi, F., Soltani, S., Zareiyan, A., & Nutbeam, D. (2025). The constructs of health literacy in children: a systematic review. BMC Public Health, 25(1), 3352.
Bandura, A. (1977). Self-Efficacy: Toward a unifying Theory of Behavioral Change. Adv. Behav,Res.Ther, 71(1), 67–85. https://doi.org/10.1017/S0003055400259303
Björk, K., Andersson, S., Hellstrand Tang, U., & Eriksson, H. (2025). The Central Role of Learning in Preventing Foot Complications in Persons With Diabetes: A Scoping Review. Journal of Clinical Nursing, 1–19. https://doi.org/10.1111/jocn.17678
Care, D., & Suppl, S. S. (2024). 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024. Diabetes Care, 47(January), S111–S125. https://doi.org/10.2337/dc24-S006
Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Education and Counseling, 99(6), 926–943. https://doi.org/10.1016/j.pec.2015.11.003
Duncan, B. B., Magliano, D. J., & Boyko, E. J. (2025). IDF diabetes atlas 11th edition 2025: global prevalence and projections for 2050. In Nephrology Dialysis Transplantation (p. gfaf177). Oxford University Press.
Gardner, D. S. L., Saboo, B., Kesavadev, J., & Mustafa, N. (2025). Digital Health Technology in Diabetes Management in the Asia – Pacific Region : A Narrative Review of the Current Scenario and Future Outlook. Diabetes Therapy, 16(3), 349–369. https://doi.org/10.1007/s13300-025-01692-0
Gökdeniz, D., & Akgün Şahin, Z. (2022). Evaluation of knowledge levels about diabetes foot care and self-care activities in diabetic individuals. The International Journal of Lower Extremity Wounds, 21(1), 65–74.
Goldfarb, M., Debigaré, S., Foster, N., Soboleva, N., Desrochers, F., Craigie, L., & Burns, K. E. A. (2022). Development of a Family Engagement Measure for the Intensive Care Unit. CJC Open, 4(11), 1006–1011. https://doi.org/https://doi.org/10.1016/j.cjco.2022.07.015
Gupta, S. K., Lakshmi, P. V. M., Chakrapani, V., Rastogi, A., & Kaur, M. (2024). Understanding the diabetes self-care behaviour in rural areas: Perspective of patients with type 2 diabetes mellitus and healthcare professionals. PLoS ONE, 19(2 February), 1–21. https://doi.org/10.1371/journal.pone.0297132
Haidan, X. (2025). Cognitive gaps and educational needs in foot self-care among patients with diabetic foot from a health literacy perspective: A qualitative study. Journal of Tissue Viability, 100960.
Hijazi, H., Al Abdi, R., Abuhammad, S., Bani Issa, W., Al-Sharman, A., Saadeh, N., AlMarzooqi, A., Refaat Ahmed, F., Hossain, A., & Radwan, H. (2025). Assessing the effectiveness of targeted educational interventions on enhancing self-efficacy and foot care practices among diabetic women in Jordan. Frontiers in Public Health, 12, 1502781.
Hutahaean, R. E., Bukit, E. K., Nasution, S. S., Wahyuni, A. S., & Tarigan, M. (2024). Pengaruh edukasi kesehatan terhadap efikasi diri dan kontrol gula darah penderita diabetes melitus. 18(9), 1173–1181.
Islam, M. S., Wei, P., Suzauddula, M., Nime, I., Feroz, F., Acharjee, M., & Pan, F. (2024). The interplay of factors in metabolic syndrome: understanding its roots and complexity. Molecular Medicine, 30(1), 279.
Jafari, A., Moshki, M., Ghelichi-Ghojogh, M., & Nejatian, M. (2024). Role of diabetes health literacy, psychological status, self-care behaviors, and life satisfaction in predicting quality of life in type 2 diabetes. Scientific Reports, 14(1), 1635.
Jasbi, P., Mohr, A. E., Murthy, M. H. S., & Klein-Seetharaman, J. (2025). Understanding metabolic resilience by unraveling temporal dynamics of cellular responses. Trends in Endocrinology & Metabolism.
Kim, H.-J. (2025). Associations between Self-esteem, Social Support, Family Empowerment, and Health Empowerment among Children during the COVID-19 Pandemic. Research in Community and Public Health Nursing, 36(1), 49–58.
Knoedler, S., Matar, D. Y., Friedrich, S., Knoedler, L., Haug, V., Hundeshagen, G., Kauke-Navarro, M., Kneser, U., Pomahac, B., & Orgill, D. P. (2023). The surgical patient of yesterday, today, and tomorrow—a time-trend analysis based on a cohort of 8.7 million surgical patients. International Journal of Surgery, 109(9), 2631–2640.
Ladesvita, F., Ayu Made Adyani, S., Dea Rosaline, M., Sholihatunnisa, D., Ilmu Kesehatan, F., & Pembangunan Nasional Veteran Jakarta, U. (2022). Pengaruh Paket Edukasi Sehabid Terhadap Kualitas Hidup Penderita Hipertensi Dan Diabetes Melitus. Jurnal Keperawatan Widya Gantari Indonesia, 6(1), 89–95. https://ejournal.upnvj.ac.id/index.php/Gantari/article/view/4051
Lopez-Garrido, G. (2023). Bandura’s self-efficacy theory of motivation in psychology. Simply Psychology, 10(1).
Mabayoje, A. (2025). The Role of Digital Technology in the Self-Management of Type 2 Diabetes Among the Aging Population, in the United Kingdom. A Systematic Literature Review. University of Wales Trinity Saint David.
Rahmayanti, Y. N. (2020). Pengaruh Promosi Kesehatan Keluarga Terhadap Peran Keluarga Dalam Pengelolaan Anggota Keluarga Dengan Diabetes Mellitus Di Puskesmas Kebakkrmat I Yeni. INFOKES, 10(2), 5–11.
Sadeghi, M. A., Raiesifar, A., & Aazami, S. (2025). Beyond Compliance: The Role of Self‐Efficacy in Foot Care and Self‐Management Among Patients With Type 1 Diabetes. The Scientific World Journal, 2025(1), 8848211.
Salmanpour, N., Salehi, A., Nemati, S., Rahmanian, M., Zakeri, A., Drissi, H. B., & Shadzi, M. R. (2025). The effect of self-care, self-efficacy, and health literacy on health-related quality of life in patients with hypertension: a cross-sectional study. BMC Public Health, 25(1), 2630.
Selano, M. K., Marwaningsih, V. R., & Setyaningrum, N. (2020). Pemeriksaan Gula Darah Sewaktu (GDS) dan Tekanan Darah kepada Masyarakat. Indonesian Journal of Community Services, 2(1), 38. https://doi.org/10.30659/ijocs.2.1.38-45
Simonsen, M. B., Christiansen, S. L., Pedersen, M. K., Røikjer, J., Croosu, S. S., Derek, P., Leutscher, C., & Ejskjaer, N. (2024). Health literacy and cognitive function in people with diabetic foot ulcer with focus on knowledge, attitude , and practice in relation to foot self-care. SAGE Open Medicine, 12, 1–12. https://doi.org/10.1177/20503121241258841
Suglo, J. N. (2024). Improving foot self-care for people with diabetes in Ghana: development and feasibility clinical trial of a family-oriented diabetic foot care intervention. In King College London.
Suglo, J. N., Winkley, K., & Sturt, J. (2024). Improving foot self-care in people with diabetes in Ghana: A development and feasibility randomised trial of a context-appropriate, family-oriented diabetic footcare intervention. PLoS ONE, 19(5 May), 1–22. https://doi.org/10.1371/journal.pone.0302385
Veryanti, P. R., Yunir, E., Saptaningsih, A. B., & Sauriasari, R. (2025). Factors affecting mortality in diabetic foot ulcer infection patients in national referral hospital, Jakarta , Indonesia : 4-year cross- sectional study. Journal of Applied Pharmaceutical Science, 15(04), 262–273. https://doi.org/10.7324/JAPS.2025.209241
Xu, X., Zheng, S., Cao, Z., Jiang, H., Shi, L., Wang, Z., & Xu, H. (2024). Evaluation of diabetic foot care knowledge, determinants of self‐care practices and the efficacy of health education. International Wound Journal, 21(2), e14704.
