Latent profile analysis of foot self-care behavior and its influencing factors in patients with high-risk diabetic foot

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Abstract Background Individual differences exist in foot self-care behaviors among patients with high-risk diabetic foot (HRDF), yet classification studies based on population heterogeneity remain limited. This study aims to identify latent profiles of foot self-care behaviors in HRDF patients and to explore their influencing factors. Methods A cross-sectional study was conducted. From May 2025 to January 2026, 402 HRDF patients admitted to the Endocrinology Department of a tertiary hospital in Shanghai were recruited. Data were collected using the General Information, the Foot Care Behavior Questionnaire for Diabetic Patients, the Diabetes Self-Efficacy Scale, the Diabetes Attitude Scale-3, the Diabetic Foot Care Knowledge Questionnaire, and the Social Support Rating Scale. The structure of the Foot Care Behavior Questionnaire for Diabetic Patients was optimized using confirmatory factor analysis (CFA); latent profile analysis (LPA) was employed to identify behavioral subtypes, and multinomial logistic regression was used to analyze the influencing factors. Results Confirmatory factor analysis (CFA) optimized the 17 items into four dimensions (cleaning and changing socks, inspection and care, footwear and sock selection, and risky behaviors) and six single items. LPA identified four behavioral profiles: “Basic Deficit” (15.7%), “Inspection Neglect” (19.4%), “Trimming Deficiency” (37.1%), and “Good Overall” (27.9%). Using the “Good Overall” profile as the reference, multinomial logistic regression revealed that a higher BMI was a risk factor for the “Inspection Neglect” profile (OR = 1.10, P < 0.05). Conversely, higher self-efficacy served as a common protective factor for the “Basic Deficit”, “Inspection Neglect”, and “Trimming Deficiency” profiles (OR = 0.66–0.78, all P < 0.01). Other factors (knowledge, attitude, and diabetic retinopathy) exhibited weaker or profile-specific associations. Conclusion Four heterogeneous profiles of foot self-care behavior exist among patients with HRDF. Self-efficacy is the strongest protective factor distinguishing the profiles, while knowledge shows a weaker independent effect, and attitude exhibits a complex bidirectional pattern. Diabetic retinopathy is associated with better self-care behaviors. This four-profile taxonomy provides a practical tool for stratified ulcer prevention in public health practice.