# Development of a supportive-educative nursing model based on health promotion for independent wound care in diabetic foot ulcer patients: A cross-sectional study

## TL;DR

A new nursing model was developed to help diabetic foot ulcer patients care for their wounds independently, based on health promotion and supportive education.

## Contribution

The study introduces a novel supportive-educative nursing model for diabetic foot ulcer patients, emphasizing patient commitment as a key mediator.

## Key findings

- Supportive-educative nursing is strongly linked to patient commitment (β = 0.724, p < 0.001).
- Patient commitment is significantly associated with independent wound care behaviors (β = 0.486, p < 0.001).
- Individual, support and facilities, and nurse factors are significantly associated with supportive-educative nursing.

## Abstract

Diabetic foot ulcers are a chronic complications of diabetes associated with substantial morbidity, amputation risk, and reduced quality of life. Promoting the patients’ capacity for independent wound care is a key component of long-term management. Although health promotion and supportive–educative nursing approaches are widely advocated in nursing, empirically informed models specifically addressing independent wound care in diabetic foot ulcer patients remain limited, particularly in low-income and middle-income countries.

To develop a supportive–educative nursing model based on health promotion for independent wound care in patients with diabetic foot ulcers.

A cross-sectional study was conducted during the model development phases.

Twenty-two community health centers in Bandar Lampung, Indonesia.

A total of 130 patients with grade 1–2 diabetic foot ulcers were recruited using purposive sampling, based on predefined inclusion and exclusion criteria.

This study represents the development phase of this model. Quantitative data were collected using validated questionnaires assessing individual factors, support and facilities factors, nursing factors, supportive–educative nursing, patient commitment, and independent wound care behaviors. Structural equation modeling using partial least squares was applied to examine associations among constructs and inform model development.

Individual (β = 0.399, p = 0.002), support and facilities (β = 0.227, p = 0.022), and nurse (β = 0.296, p < 0.001) factors were significantly associated with supportive–educative nursing. Supportive–educative nursing was strongly associated with patient commitment (β = 0.724, p < 0.001), which in turn was associated with independent wound care behaviors (β = 0.486, p < 0.001). Direct associations between support and facilities and nurse factors and independent wound care were not significant, consistent with an indirect pathway through supportive–educative nursing and patient commitment.

This study proposes a health promotion–based supportive–educative nursing model in which patient commitment functions as a key mediating pathway linking nursing support to independent wound care. These findings provide an empirically informed framework to guide nursing practice and support future longitudinal and interventional research.

The Health Research Ethics Committee of Universitas Airlangga (Ref. No. 3664-KEPK), Investment and One-Stop Integrated Services Agency (Reference number 1871/070/06354/SKP/III.16/II/2025), and Bandar Lampung City Health Agency (Reference number B/400.7.22/III.02.V/02/2025).