Impact of social and psychological factors on foot self-care in diabetic foot patients: Based on variable-centered and individual-centered analysis

Diabetic foot (DF) is a serious diabetes complication that increases ulceration, amputation and mortality risks. Effective foot self-care can prevent up to 85% of ulcer events. This study aimed to assess foot self-care behaviors among middle-aged and older DF patients, evaluate the impact of social support, and explore the mediating effects of frailty and fear of progression (FoP). We also identified patient subtypes using latent profile analysis. A cross-sectional study was conducted in a tertiary hospital from November 2024 to March 2025. A total of 361 patients with DF aged ≥45 years completed validated questionnaires, including the Social Support Rating Scale (SSRS), FRAIL Scale, FoP-Q-SF, and DFSQ-UMA. Structural equation modeling (SEM) assessed mediation effects, and latent profile analysis (LPA) identified subgroups based on frailty and FoP. A total of 383 questionnaires were distributed, with 361 valid responses collected, resulting in an effective response rate of 94.3%. The average score for foot self-care behavior was 58.52 ± 13.46, while levels of social support, frailty, and FoP were all at moderate levels. SEM indicated that Social support significantly predicted better foot self-care behavior ( β = 0.225, P < 0.01). Frailty and FoP partially mediated this relationship (mediation effect: 6.68%). LPA identified three types of physical and mental profiles: Low FoP - Low Frailty Group (75.1%), Moderate FoP - Moderate Frailty Group (15.2%), and High FoP - High Frailty Group (9.7%). Importantly, patients in the High FoP–High Frailty Group demonstrated the lowest foot self-care behavior (mean = 43.70, P < 0.001), indicating the highest potential risk for ulcer occurrence and poor tissue outcomes. Social support enhances foot self-care in DF patients through reduced Frailty and FoP. Tailored interventions targeting high-risk subgroups may improve tissue outcomes and prevent ulcers. • Social support was positively associated with foot self-care, partly mediated by frailty and fear of progression. • A three-class latent profile based on frailty and FoP was identified among patients. • High frailty and high fear of progression were linked to the poorest foot self-care and highest ulcer risk. • These findings inform ulcer prevention strategies and nursing practice to improve tissue viability in high-risk patients.