Abstract / Summary
Diabetic foot disease imposes a compounding burden on patients with diabetes, yet whether physician-delivered formal counselling—defined as structured, intentional foot care education delivered by a healthcare professional during a clinical encounter—confers measurable advantages over non-physician or informal sources—including internet, social media, family advice, or incidental mention—in shaping knowledge and health-seeking behavioral intention remains untested in Saudi Arabia—a critical gap given the country's exceptionally high diabetes prevalence and limited protocolized foot education delivery. A cross-sectional survey was administered to 575 adults with diabetes attending primary health care clinics of the Armed Forces Hospital Southern Region (AFHSR), Khamis Mushait, Asir Region, Saudi Arabia, following exclusion of 20 pilot-phase participants. Two composite instruments were computed: a 21-item Diabetic Foot Knowledge Score (DFKS; range 21–105) and a 9-item Health-Seeking Behavior Score (HSBS; range 9–45). Group comparisons used Mann–Whitney U and Kruskal–Wallis tests; Spearman correlation examined inter-domain associations. Mean DFKS was 64.72 (SD 5.38; median 65.0, IQR 61.0–68.0, observed range 48–79) and mean HSBS was 24.42 (SD 3.67; median 24.0, IQR 22.0–27.0, observed range 15–36). No floor or ceiling effects were observed. Only 45.7% received formal foot care education; physicians were the identified educator in 55.1% of those cases. Among formally educated participants, educator type combinations were: physician only 80 (13.9%), nurse only 63 (11.0%), diabetes educator only 39 (6.8%), pharmacist only 4 (0.7%), physician and nurse 33 (5.7%), physician and diabetes educator 22 (3.8%), nurse and diabetes educator 13 (2.3%), and physician, nurse, and diabetes educator 9 (1.6%). Six misconception items recorded majority-level false belief endorsement, anchored to a pain-as-danger heuristic incompatible with diabetic neuropathy. Physician-educated and non-physician-educated patients did not differ significantly in DFKS (U = 32,180; p = 0.920) or HSBS (U = 29,380; p = 0.115). DFKS and HSBS were uncorrelated (rho = 0.013; p = 0.758), and self-rated knowledge did not predict objective scores (rho = − 0.003; p = 0.937). Physician-delivered education was not associated with superior foot care knowledge or more proactive care-seeking intention compared with non-physician sources. Pain-centric misconceptions and knowledge-intention dissociation were observed across all education-source groups. Standardized, misconception-targeted protocols—deployed through physicians, nurses, and digital resources—are urgently required within every routine diabetic consultation.