{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T04:46:51Z","timestamp":1780375611045,"version":"3.54.1"},"reference-count":54,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T00:00:00Z","timestamp":1755907200000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The rising prevalence of diabetic foot ulcers (DFUs) highlights the need for effective self\u2010care interventions. Despite strong evidence supporting their effectiveness, patient engagement, uptake, and integration into routine care remain limited. Co\u2010design approaches can enhance the relevance and adoption of interventions but are underutilized in DFU management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study outlines the development of Healing through Empowerment and Active Listening (HEALing), a self\u2010care intervention for patients with DFU, grounded in Self\u2010Determination Theory and Motivational Interviewing, and developed using an experience\u2010based co\u2010design approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting and Participants<\/jats:title>\n                    <jats:p>\n                      The 27\u2010month co\u2010design process consisted of three phases involving patients, caregivers, and healthcare professionals (HCPs) from across a primary care cluster in Singapore. Phase 1 (16 months) included qualitative interviews with patients (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200927), caregivers (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20095), and HCPs\u00a0(\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20098), analyzed via reflexive thematic analysis, alongside a quantitative survey (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009186), analyzed using structural equation modelling to identify intervention determinants. Phase 2 (9 months) involved co\u2010design workshops with patients (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200910) and wound care nurses (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20096) to define the intervention's content and delivery approach. In Phase 3 (2 months), iterative meetings refined the intervention's procedures, tools, and materials. Qualitative data from Phases 2 and 3 were thematically analyzed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Key barriers to DFU self\u2010care included limited control over ulceration and treatment, low confidence, negative emotions, and misperceptions about the condition. Personalised care and clinician\u2010facilitated motivation emerged as key enablers. HEALing targets five core self\u2010care components: (1) wound care, (2) foot care and footwear, (3) diabetes care, (4) treatment seeking, and (5) managing worries and concerns. The personalised components are delivered using a card\u2010sorting tool during clinic\u2010integrated sessions by trained wound care nurses. The HEALing delivery pathway comprises three 30\u2010min sessions at 2\u2010week intervals. During workshops, participants perceived HEALing as supporting patient\u2010 and clinician\u2010endorsed person\u2010centred care and collaborative planning, while also identifying potential implementation challenges, including training needs and structural barriers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HEALing positions patients as experts by experience, addressing the psychological and behavioural complexities of DFU care. This nurse\u2010led and stakeholder\u2010endorsed intervention is currently undergoing feasibility evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient and Public Involvement<\/jats:title>\n                    <jats:p>Individuals with DFUs, their caregivers, and those in with post\u2010healing remission, and wound care nurses contributed to the co\u2010design of HEALing by identifying intervention targets and informing the intervention's content and delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hex.70386","type":"journal-article","created":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T11:45:34Z","timestamp":1755949534000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Healing Through Empowerment and Active Listening: Experience\u2010Based Co\u2010Design of a Nurse\u2010Led Personalised Self\u2010Care Support Intervention for Primary Care Patients With Diabetic Foot Ulcers"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3406-6203","authenticated-orcid":false,"given":"Xiaoli","family":"Zhu","sequence":"first","affiliation":[{"name":"NHG Polyclinics, NHG Health  Singapore"},{"name":"Nanyang Technological University Lee Kong Chian School of Medicine  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4963-535X","authenticated-orcid":false,"given":"Eng Sing","family":"Lee","sequence":"additional","affiliation":[{"name":"Nanyang Technological University Lee Kong Chian School of Medicine  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9905-3422","authenticated-orcid":false,"given":"Frederick H. 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