Healing through empowerment and active listening (HEALing): A mixed-methods evaluation of the feasibility and acceptability of a nurse-led self-care support intervention for people with diabetic foot ulcers

Abstract

Aims: To evaluate the feasibility, acceptability, and implementation of HEALing (Healing through Empowerment and Active Listening)—a clinic-integrated self-care intervention delivered by trained wound care nurses in three 30-min face-to-face sessions over 6 weeks to support diabetic foot ulcer healing. Methods: A mixed-methods, single-arm hybrid effectiveness–implementation pilot and qualitative study was conducted. Feasibility was evaluated through enrolment, retention, attendance and data completeness; acceptability via qualitative interviews; and implementation by tracking intervention delivery time. Potential effectiveness was assessed through changes in psychological (illness beliefs, foot care confidence, diabetes distress, quality of life, autonomy support), behavioural (foot care practices), knowledge (of wound deterioation), and clinical (HbA1c) outcomes from baseline to 4 weeks post intervention. Data were analysed using descriptive statistics, paired-sample t-tests and thematic analysis. Results: A total of 29 individuals living with DFU participated in the study (response rate: 78%), with enrolment occurring between August and September 2024. Retention was 90% (N = 26). The average HEALing session lasted 32 min (range: 15–50 min). Statistically significant improvements were observed across psychological, behavioural, knowledge and clinical outcomes from baseline to post-intervention (all p < 0.005; Cohen's d = 0.8–1.1). Qualitative findings reinforced the intervention's acceptability, highlighting how HEALing enhanced knowledge, emotional healing and empowerment through autonomy,fostering greater motivation and engagement in self-care. Conclusions: This pilot suggests the feasibility and acceptability of HEALing in nurse-led DFU care, with preliminary indications of psychological and clinical benefits. The findings support the potential for scalable integration of psychological support, warranting further evaluation in larger, controlled trials with extended follow-up.