{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:09:07Z","timestamp":1793210947331,"version":"4.5.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Digital health literacy was moderately positively correlated with self-management behaviors (\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.42,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01). Self-efficacy was strongly positively correlated with self-management behaviors (\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.53,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1850957","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:50:15Z","timestamp":1782280215000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The relationship between digital health literacy, self-efficacy, and self-management behaviors in patients with diabetes-related foot disease: a cross-sectional study"],"prefix":"10.3389","volume":"14","author":[{"given":"Jianxia","family":"Yao","sequence":"first","affiliation":[{"name":"Department of Burn and Plastic Surgery, The First Hospital of Putian City","place":["Putian, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongxin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Burn and Plastic Surgery, The First Hospital of Putian City","place":["Putian, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinqi","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Interventional Vascular Surgery, The First Hospital of Putian City","place":["Putian, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiqi","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Hospital of Putian City","place":["Putian, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuping","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Burn and Plastic Surgery, The First Hospital of Putian City","place":["Putian, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanshan","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Burn and Plastic Surgery, The First Hospital of Putian City","place":["Putian, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiqiong","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Nutrition, The First Hospital of Putian City","place":["Putian, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baogen","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Burn and Plastic Surgery, The First Hospital of Putian City","place":["Putian, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruilin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Burn and Plastic Surgery, The First Hospital of Putian City","place":["Putian, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Psychology, The First Hospital of Putian City","place":["Putian, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Hospital of Putian City","place":["Putian, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"6715157","DOI":"10.1155\/jdr\/6715157","article-title":"Challenges and solutions in advanced management of diabetic foot infections: a review of recent studies","volume":"2025","author":"Rashki","year":"2025","journal-title":"J Diabetes 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