{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T04:08:53Z","timestamp":1793333333208,"version":"4.5.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"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":"\n Background<\/jats:title>\n Diabetic foot is a serious and largely preventable complication of diabetes. Patient knowledge, attitudes, and practices (KAP) regarding foot care are central to early prevention, yet the overall distribution of KAP levels among patients with diabetes in China remains unclear. This systematic review and meta-analysis aimed to estimate the pooled proportions of different levels of diabetic foot care-related KAP among patients with diabetes in China.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The review was registered in PROSPERO (CRD420261328954) and followed PRISMA 2020 reporting guidance. PubMed, Embase, Scopus, the Cochrane Library, Web of Science, CINAHL Complete, SinoMed, CNKI, Wanfang, and VIP were searched from inception to March 2, 2026. Cross-sectional studies reporting extractable diabetic foot-care KAP data among Chinese adults with diabetes were included. Study quality was assessed using the 11-item Agency for Healthcare Research and Quality checklist. Random-effects proportion meta-analyses used the Freeman-Tukey double arcsine transformation. Subgroup, sensitivity, and small-study effect analyses were conducted where data allowed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Twenty-four cross-sectional studies involving 6,124 participants across 13 Chinese provinces or municipalities were included. Fourteen studies contributed to the meta-analysis of knowledge, five to attitudes, and seventeen to practices. The pooled proportions of poor, satisfactory, and good knowledge were 33% (95% CI: 19\u201348%), 43% (95% CI: 33\u201354%), and 26% (95% CI: 17\u201337%), respectively. For attitudes, 33% (95% CI: 10\u201362%) of participants had unfavorable attitudes and 67% (95% CI: 38\u201390%) had favorable attitudes. For practices, the pooled proportions of poor, satisfactory, and good foot care practices were 45% (95% CI: 35\u201355%), 45% (95% CI: 38\u201353%), and 10% (95% CI: 6\u201314%), respectively. Substantial heterogeneity was observed across most outcomes, and subgroup analyses did not identify statistically significant differences by study region, diabetic foot status, or publication period.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Chinese patients with diabetes generally showed favorable attitudes toward diabetic foot care, but knowledge remained insufficient and good foot-care practices were uncommon. Because all included studies were cross-sectional, the pooled estimates primarily characterize the distribution of KAP levels and should be interpreted descriptively. When considered alongside existing guidelines and intervention evidence, these findings may inform the development of risk-stratified, behavior-oriented, and system-supported strategies for diabetic foot prevention.<\/jats:p>\n <\/jats:sec>\n \n Systematic review registration<\/jats:title>\n \n Publicly accessible record:\n https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261328954<\/jats:ext-link>\n . PROSPERO registration: CRD420261328954.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1922404","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:29:15Z","timestamp":1788499755000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Knowledge, attitudes, and practices regarding diabetic foot care among patients with diabetes in China: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Yong","family":"Xiao","sequence":"first","affiliation":[{"name":"School of Nursing, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiyun","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Nursing, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueyue","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Nursing, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Wang","sequence":"additional","affiliation":[{"name":"Dean\u2019s Office, Guang\u2019an Hospital of Traditional Chinese Medicine","place":["Guang'an, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.2337\/dci22-0043","article-title":"Etiology, epidemiology, and disparities in the burden of diabetic foot ulcers","volume":"46","author":"McDermott","year":"2023","journal-title":"Diabetes Care"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/S2213-8587(25)00299-2","article-title":"11th edition of the IDF diabetes atlas: global, regional, and national diabetes prevalence estimates for 2024 and projections for 2050","volume":"14","author":"Genitsaridi","year":"2026","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s40779-025-00615-1","article-title":"The national and provincial prevalence and non-fatal burdens of diabetes in China from 2005 to 2023 with projections of prevalence to 2050","volume":"12","author":"Zhou","year":"2025","journal-title":"Mil Med Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s13047-020-00383-2","article-title":"Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer","volume":"13","author":"Armstrong","year":"2020","journal-title":"J Foot Ankle Res"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"964","DOI":"10.2337\/dc19-1614","article-title":"Global disability burdens of diabetes-related lower-extremity complications in 1990 and 2016","volume":"43","author":"Zhang","year":"2020","journal-title":"Diabetes Care"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e0182081","DOI":"10.1371\/journal.pone.0182081","article-title":"Incidence of lower extremity amputations in the diabetic compared with the non-diabetic population: a systematic review","volume":"12","author":"Narres","year":"2017","journal-title":"PLoS One"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"S252","DOI":"10.2337\/dc25-S012","article-title":"12. Retinopathy, neuropathy, and foot care: standards of care in diabetes\u20142025","volume":"48","year":"2024","journal-title":"Diabetes Care"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e3651","DOI":"10.1002\/dmrr.3651","article-title":"Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update)","volume":"40","author":"Bus","year":"2024","journal-title":"Diabetes Metab Res Rev"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1002\/dmrr.2696","article-title":"IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes","volume":"32","author":"Bus","year":"2016","journal-title":"Diabetes Metab Res Rev"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e3746","DOI":"10.1002\/dmrr.3746","article-title":"Effectiveness of educational interventions for diabetes-related foot disease: a systematic review and meta-analysis","volume":"40","author":"Drovandi","year":"2024","journal-title":"Diabetes Metab Res Rev"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e00614","DOI":"10.1016\/j.heliyon.2018.e00614","article-title":"A systematic review and meta-analysis of patient education in preventing and reducing the incidence or recurrence of adult diabetes foot ulcers (DFU)","volume":"4","author":"Adiewere","year":"2018","journal-title":"Heliyon"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"100988","DOI":"10.1016\/j.jtv.2026.100988","article-title":"Analysis on the current status of foot self-management and influencing factors of high-risk diabetic foot patients based on COM-B model","volume":"35","author":"Xia","year":"2026","journal-title":"J Tissue Viability"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"100960","DOI":"10.1016\/j.jtv.2025.100960","article-title":"Cognitive gaps and educational needs in foot self-care among patients with diabetic foot from a health literacy perspective: a qualitative study","volume":"34","author":"Lin","year":"2025","journal-title":"J Tissue Viability"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"28152","DOI":"10.1038\/s41598-025-13735-4","article-title":"Knowledge, attitudes, and practices among patients with diabetic foot ulcers towards disease management","volume":"15","author":"Xie","year":"2025","journal-title":"Sci Rep"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1016\/j.ijnss.2014.05.023","article-title":"The current status of foot self-care knowledge, behaviours, and analysis of influencing factors in patients with type 2 diabetes mellitus in China","volume":"1","author":"Li","year":"2014","journal-title":"Int J Nurs Sci"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s40779-020-00238-8","article-title":"Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better?","volume":"7","author":"Ma","year":"2020","journal-title":"Mil Med Res"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"10","DOI":"10.3870\/hlxzz.2010.05.010","article-title":"Relationship between self-management behaviors and activation in patients with type 2 diabetes mellitus","volume":"25","author":"Lianggui","year":"2010","journal-title":"J Nurs Sci"},{"key":"ref19","first-page":"106","article-title":"An investigation of the cognition and behaviors about diabetes' foot prevention knowledge among the diabetes meilitus","volume":"10","author":"Enhe","year":"2011","journal-title":"J Anhui Med College"},{"key":"ref20","first-page":"336","article-title":"Evaluation of foot self-care activities in older patients with diabetes in Shenzhen population","volume":"32","author":"Ting","year":"2011","journal-title":"Jilin Med J"},{"key":"ref21","first-page":"57","article-title":"Investigative study on foot care knowledge and behaviors among community patients with type 2 diabetes mellitus","volume":"27","author":"Hongju","year":"2013","journal-title":"J Hubei Univ Sci Technol (Med Sci)"},{"key":"ref22","first-page":"1357","article-title":"An investigation of foot care behavior in patients with high risk of type 2 diabetic foot and analysis of influencing factors","volume":"31","author":"Li","year":"2015","journal-title":"Chin J Pract Nurs."},{"key":"ref23","first-page":"114","article-title":"Study on the current status and influencing factors of foot care knowledge and foot self-care behaviors in patients with type 2 diabetes mellitus","volume":"22","author":"Liping","year":"2016","journal-title":"Psychol Doctor"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"600","DOI":"10.3969\/j.issn.1009-6493.2017.05.028","article-title":"Survey of status quo of foot care knowledge and behavior of patients with grade 0 diabetic foot in suburban community in Shanghai","volume":"31","author":"Enfang","year":"2017","journal-title":"Chin Nurs Res"},{"key":"ref25","author":"Liangqin","year":"2019"},{"key":"ref26","first-page":"2086","article-title":"An investigation of foot care behavior and multiple linear regression analysis of influential factors in patients with type 2 diabetes mellitus in Jinshan District of Shanghai","volume":"35","author":"Xu","year":"2019","journal-title":"Chin J Pract Nurs"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"678","DOI":"10.11712\/jms.2096-5532.2020.56.168","article-title":"Self-management of patients with diabetic foot based on health ecological model","volume":"56","author":"Liu","year":"2020","journal-title":"J Qingdao Univ (Med Sci)"},{"key":"ref28","author":"Miaomiao","year":"2020"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"207","DOI":"10.2147\/DMSO.S236966","article-title":"Relationship between self-care behavior and cognitive function in hospitalized adult patients with type 2 diabetes: a cross-sectional study","volume":"13","author":"Yang","year":"2020","journal-title":"Diabetes Metab Syndr Obes"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"48","DOI":"10.3969\/j.issn.1672-6170.2021.01.014","article-title":"Analysis of foot care self-efficacy level in high-risk inpatients with diabetic foot","volume":"18","author":"Long","year":"2021","journal-title":"Pract J Clin Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1276","DOI":"10.13898\/j.cnki.issn.1000-2200.2021.09.033","article-title":"Self-management behaviors and effects of type 2 diabetic foot patients under the health ecology model factor analysis","volume":"46","author":"Qin","year":"2021","journal-title":"J Bengbu Med Univ"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"160","DOI":"10.3969\/j.issn.1671-5217.2021.25.QKBJBD20212021083000006788","article-title":"Analysis of factors influencing the current status of knowledge, attitude and practice of blood glucose self-management in patients with type 2 diabetic foot","volume":"22","author":"Ting","year":"2021","journal-title":"Bao Jian Wen Hui"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"23","DOI":"10.3870\/j.issn.1001-4152.2021.19.023","article-title":"Stages of foot self-care behavior among patients at high-risk of diabetic foot: the influencing factors","volume":"36","author":"Yang","year":"2021","journal-title":"J Nurs Sci"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"876105","DOI":"10.3389\/fpubh.2022.876105","article-title":"Knowledge, attitudes, and practices associated with diabetic foot prevention among rural adults with diabetes in North China","volume":"10","author":"Jia","year":"2022","journal-title":"Front Public Health"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"102","DOI":"10.3870\/j.issn.1001-4152.2022.13.102","article-title":"Investigation and analysis of foot skin problems in elderly diabetic patients in community","volume":"37","author":"Lin","year":"2022","journal-title":"J Nurs Sci"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e12550","DOI":"10.1111\/jjns.12550","article-title":"Relationship between illness perception and self-management behaviors among Chinese diabetic foot patients","volume":"20","author":"Chenxia","year":"2023","journal-title":"Jpn J Nurs Sci"},{"key":"ref37","author":"Na","year":"2023"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"4682","DOI":"10.3760\/cma.j.cn115682-20230731-00284","article-title":"Correlation between frailty and foot care behavior in elderly patients with high-risk diabetic foot","volume":"29","author":"Qiuping","year":"2023","journal-title":"Chin J Mod Nurs"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"44","DOI":"10.18502\/npt.v10i1.12256","article-title":"Factors influencing foot care behavior among patients with type 2 diabetes mellitus who have a high-risk diabetic foot in China","volume":"10","author":"Yi-Jun","year":"2023","journal-title":"Nurs Pract Today"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1186\/s12875-025-03111-6","article-title":"Self-management of patients with type 2 diabetes in Chaoyang District, Beijing, and challenges in utilizing family and community resources: a mixed-methods study","volume":"26","author":"Qi","year":"2025","journal-title":"BMC Prim Care"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"479","DOI":"10.3969\/j.issn.1671-301X.2025.04.039","article-title":"A study on the correlation between diabetic distress and self-management behaviors in patients with diabetic foot","volume":"30","author":"Xiaomei","year":"2025","journal-title":"Lingnan J Emerg Med"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"92","DOI":"10.3760\/cma.j.issn.1674-5809.2019.02.004","article-title":"Chinese guideline on prevention and management of diabetic foot (2019 edition) (I)","volume":"11","year":"2019","journal-title":"Chin J Diabetes Mellitus"},{"key":"ref43","first-page":"tkaf064","year":"2025"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.jcte.2015.01.001","article-title":"The relationship between self-efficacy and diabetic foot self-care","volume":"2","author":"Wendling","year":"2015","journal-title":"J Clin Transl Endocrinol"},{"key":"ref45","first-page":"2","article-title":"Self-efficacy of foot care behaviour of elderly patients with diabetes","volume":"12","author":"Ahmad Sharoni","year":"2017","journal-title":"Malays Fam Physician"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"2764","DOI":"10.1111\/iwj.14153","article-title":"Exploring barriers and enablers of self-management behaviours in patients with diabetic foot ulcers: a qualitative study from the perceptions of patients, caregivers, and healthcare professionals in primary care","volume":"20","author":"Zhu","year":"2023","journal-title":"Int Wound J"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"e0302385","DOI":"10.1371\/journal.pone.0302385","article-title":"Improving foot self-care in people with diabetes in Ghana: a development and feasibility randomised trial of a context appropriate, family-orientated diabetic footcare intervention","volume":"19","author":"Suglo","year":"2024","journal-title":"PLoS One"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/j.diabres.2017.04.013","article-title":"IDF clinical practice recommendation on the diabetic foot: a guide for healthcare professionals","volume":"127","author":"Ibrahim","year":"2017","journal-title":"Diabetes Res Clin Pract"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"e70295","DOI":"10.1111\/nhs.70295","article-title":"Effectiveness of mobile health technology-based interventions on foot care behaviors, knowledge and beliefs in patients with diabetes: a systematic review and meta-analysis","volume":"28","author":"Zhang","year":"2026","journal-title":"Nurs Health Sci"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"e40000","DOI":"10.2196\/40000","article-title":"A nurse-led telehealth program for diabetes foot care: feasibility and usability study","volume":"6","author":"Ju","year":"2023","journal-title":"JMIR Nurs"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1922404\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:29:25Z","timestamp":1788499765000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1922404\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":50,"alternative-id":["10.3389\/fpubh.2026.1922404"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1922404","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]},"article-number":"1922404"}}