Foot self-care practices among adults with diabetes in the West Bank, Palestine: A cross-sectional study

Diabetic foot complications are a major cause of morbidity and disability yet are largely preventable through proper self-care. This cross-sectional study assessed foot self-care practices among adults with diabetes in the West Bank, Palestine, and identified factors associated with adherence. We interviewed 300 adults attending diabetes clinics at four sites using a structured questionnaire adapted from a published foot-care instrument. Foot self-care was measured using an 11-item frequency scale (score range 0-44), with higher scores indicating better adherence; the scale showed acceptable internal consistency (Cronbach's alpha = 0.81). Overall adherence was suboptimal: although 80.9% reported washing their feet daily, only 33.1% inspected their feet daily, 45.1% dried between toes, and 40.3% inspected shoes. Risky behaviors were common, including soaking feet (28.6%), walking barefoot (20.2%), and wearing shoes without socks (15.9%). Only 13% reported performing all recommended behaviors daily. In multivariable analysis, higher income, higher educational attainment, and longer diabetes duration were associated with better adherence, and male sex was associated with lower adherence in the ordinal logistic model. These findings highlight important gaps in preventive foot self-care in the West Bank, driven by socioeconomic and educational disparities and limited clinical reinforcement, underscoring the need for culturally tailored education and routine provider-led counseling and screening to reduce diabetic foot complications.