Cognitive gaps and educational needs in foot self-care among patients with diabetic foot from a health literacy perspective: A qualitative study

The self-care difficulties of Wagner stage 0 DF patients stem from a multi-dimensional deficit in health literacy: a disconnect between risk perception and the understanding of the behavioral cause-and-effect chain at the cognitive level, behavioral capabilities restricted by both physical and social factors, a communication gap due to a lack of terminology and resource discontinuity, and the vicious cycle of misinformation and risk insensitivity. This study moves beyond the previous focus solely on 'knowledge deficiency,' proposing the key roles of 'causal health literacy deficiency' and 'systemic ecological dysfunction.' It calls for a paradigm shift in health literacy education from imparting 'fragmented knowledge' to fostering 'causal internalization,' and from emphasizing 'individual responsibility' to enabling 'systemic empowerment,' providing a basis for the precise design of educational strategies centered on 'causal logic and system support.'