Empowering people living with diabetes with footcare knowledge and skills: a mixed-methods feasibility study.
5 affiliations
- 1Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- 2School of Social Sciences, Nanyang Technological University, Singapore, Singapore.
- 3SingHealth Duke-NUS Global Health Institute, Duke-NUS Medical School, Singapore, Singapore.
- 4King's College London, London, UK.
- 5Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore.
Abstract
Diabetic foot ulcers (DFU) are common and serious complications of type 2 diabetes, increasing the risks of infection, amputation, and mortality. This study evaluated the participant-level feasibility and study-level feasibility of WellFeet, a multilingual diabetes footcare mobile health app (mHealth). This single-arm, pre-post mixed-methods feasibility study recruited 40 patients with type 2 diabetes and caregivers from a tertiary hospital in Singapore. Participants used the WellFeet for one month. Participant-level feasibility outcomes included usability (primary outcome), footcare knowledge, foot self-management behaviors, caregiver experience, and user engagement (secondary outcomes). Study-level feasibility outcomes included enrolment, completion, and compliance rates. Quantitative data were collected using validated questionnaires, pre-post assessments, and app usage analytics, while qualitative data were collected through focus group discussions (FGDs) and analyzed thematically. Usability findings indicated high acceptance of the WellFeet, particularly in relation to ease of use, learnability, content organization, navigation, feedback, and overall satisfaction. Footcare knowledge improved significantly following the interventions among patients and caregivers (mean score: 10.80±1.88 at baseline vs. 12.00±1.56 at follow-up). Among patients, foot self-management behaviors also improved significantly (mean score: 41.96±7.80 at baseline vs. 47.60±6.17 at follow-up). Qualitative findings generated four themes across two categories: usability comprising ease-of-use and challenges to repeated use, and impact including enhanced diabetes literacy and healthier lifestyle. Study-level feasibility indicators showed an enrollment rate of 67.7% (40/59), a completion rate of 70.0% (28/40), and a compliance rate of 40.0% (16/40). WellFeet was acceptable to patients with diabetes and caregivers and demonstrated preliminary improvements in footcare knowledge and self-management behaviors. The findings support the feasibility of both the intervention and study procedures and will inform refinements to WellFeet and design of a future randomized controlled trial evaluating intervention effectiveness. The study was registered on ClinicalTrials.gov (NCT05564728).
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BibTeX
@article{ho2026empowering,
title = {{Empowering people living with diabetes with footcare knowledge and skills: a mixed-methods feasibility study.}},
author = {Andy Hau Yan Ho and Anita Pienkowska and Chin-Siang Ang and Nandika Lodh and Kelley Fann Ing Goh and Iva Bojic and Ashwini Lawate and Qi Chwen Ong and Muhammad Daniel Azlan Mahadzir and Josip Car and Huiling Liew},
journal = {MHealth},
year = {2026},
month = aug,
doi = {10.21037/mhealth-2026-0019},
url = {https://europepmc.org/article/MED/42999802},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Empowering people living with diabetes with footcare knowledge and skills: a mixed-methods feasibility study.
AU - Andy Hau Yan Ho
AU - Anita Pienkowska
AU - Chin-Siang Ang
AU - Nandika Lodh
AU - Kelley Fann Ing Goh
AU - Iva Bojic
AU - Ashwini Lawate
AU - Qi Chwen Ong
AU - Muhammad Daniel Azlan Mahadzir
AU - Josip Car
AU - Huiling Liew
PY - 2026
DA - 2026/08/18
JO - MHealth
DO - 10.21037/mhealth-2026-0019
UR - https://europepmc.org/article/MED/42999802
AB - Diabetic foot ulcers (DFU) are common and serious complications of type 2 diabetes, increasing the risks of infection, amputation, and mortality. This study evaluated the participant-level feasibility and study-level feasibility of WellFeet, a multilingual diabetes footcare mobile health app (mHealth). This single-arm, pre-post mixed-methods feasibility study recruited 40 patients with type 2 diabetes and caregivers from a tertiary hospital in Singapore. Participants used the WellFeet for one month. Participant-level feasibility outcomes included usability (primary outcome), footcare knowledge, foot self-management behaviors, caregiver experience, and user engagement (secondary outcomes). Study-level feasibility outcomes included enrolment, completion, and compliance rates. Quantitative data were collected using validated questionnaires, pre-post assessments, and app usage analytics, while qualitative data were collected through focus group discussions (FGDs) and analyzed thematically. Usability findings indicated high acceptance of the WellFeet, particularly in relation to ease of use, learnability, content organization, navigation, feedback, and overall satisfaction. Footcare knowledge improved significantly following the interventions among patients and caregivers (mean score: 10.80±1.88 at baseline vs. 12.00±1.56 at follow-up). Among patients, foot self-management behaviors also improved significantly (mean score: 41.96±7.80 at baseline vs. 47.60±6.17 at follow-up). Qualitative findings generated four themes across two categories: usability comprising ease-of-use and challenges to repeated use, and impact including enhanced diabetes literacy and healthier lifestyle. Study-level feasibility indicators showed an enrollment rate of 67.7% (40/59), a completion rate of 70.0% (28/40), and a compliance rate of 40.0% (16/40). WellFeet was acceptable to patients with diabetes and caregivers and demonstrated preliminary improvements in footcare knowledge and self-management behaviors. The findings support the feasibility of both the intervention and study procedures and will inform refinements to WellFeet and design of a future randomized controlled trial evaluating intervention effectiveness. The study was registered on ClinicalTrials.gov (NCT05564728).
SN - 2306-9740
ER -