Development of a supportive-educative nursing model based on health promotion for independent wound care in diabetic foot ulcer patients: A cross-sectional study

Background: Diabetic foot ulcers are a chronic complications of diabetes associated with substantial morbidity, amputation risk, and reduced quality of life. Promoting the patients' capacity for independent wound care is a key component of long-term management. Although health promotion and supportive-educative nursing approaches are widely advocated in nursing, empirically informed models specifically addressing independent wound care in diabetic foot ulcer patients remain limited, particularly in low-income and middle-income countries. Objective: To develop a supportive-educative nursing model based on health promotion for independent wound care in patients with diabetic foot ulcers. Design: A cross-sectional study was conducted during the model development phases. Settings: Twenty-two community health centers in Bandar Lampung, Indonesia. Participants: A total of 130 patients with grade 1-2 diabetic foot ulcers were recruited using purposive sampling, based on predefined inclusion and exclusion criteria. Methods: This study represents the development phase of this model. Quantitative data were collected using validated questionnaires assessing individual factors, support and facilities factors, nursing factors, supportive-educative nursing, patient commitment, and independent wound care behaviors. Structural equation modeling using partial least squares was applied to examine associations among constructs and inform model development. Results: < 0.001). Direct associations between support and facilities and nurse factors and independent wound care were not significant, consistent with an indirect pathway through supportive-educative nursing and patient commitment. Conclusions: This study proposes a health promotion-based supportive-educative nursing model in which patient commitment functions as a key mediating pathway linking nursing support to independent wound care. These findings provide an empirically informed framework to guide nursing practice and support future longitudinal and interventional research. Registration: The Health Research Ethics Committee of Universitas Airlangga (Ref. No. 3664-KEPK), Investment and One-Stop Integrated Services Agency (Reference number 1871/070/06354/SKP/III.16/II/2025), and Bandar Lampung City Health Agency (Reference number B/400.7.22/III.02.V/02/2025).