Effects of Realistic Acceptance Enhancing Program on Self-Care Behaviors and Foot Health in Patients with Type 2 Diabetes in Thailand

Background/Problem: Diabetic foot ulcers (DFUs) are a common and preventable complication among individuals with type 2 Diabetes Mellitus (T2DM), often leading to lower limb amputation. Promoting effective self-care behaviors is crucial in minimizing the risk of DFUs.Objective/Purpose: The aims of this study were to design and evaluate a 12-week realistic acceptance enhancing (RAE) program in improving self-care behaviors and foot health in adults with T2DM in Thailand.Design and Methodology: A randomized controlled trial was conducted with 96 participants randomly assigned to either the experimental or control group (n = 48 per group). This program was developed based on the theory of self-care of chronic illness integrated with acceptance and commitment concepts. Research instruments included the self-care of diabetes inventory, the self-care evaluation instrument to prevent diabetic foot, Thai visual analogue scale-foot and ankle, and foot health status form.Results: The results demonstrated significant improvements in the experimental group’s self-care behaviors and foot health status at Weeks 8 and 12 (p ≤ .001), compared to the control group. No significant differences were found in pedal pulses and protective sensation.Conclusion and Implications: This health promotion initiative integrating realistic acceptance could foster psychological flexibility and value-based actions, thereby enhance self-care behavior engagement and sustain long-term foot health outcomes. Nurses and health care providers can use this program to improve adherence to self-care behaviors and promote better foot health.