Currently submitted to: Asian/Pacific Island Nursing Journal
Date Submitted: Mar 8, 2026
Open Peer Review Period: Mar 17, 2026 - May 12, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
User-Centered Design of Diabetic Foot Sandals: A Qualitative Study of Nurses’ and Patients’ Perspectives in Indonesia
ABSTRACT
Background:
Diabetic foot ulcers (DFUs) are a major complication of diabetes mellitus (DM) and contribute substantially to morbidity, disability, and the healthcare burden worldwide. Appropriate footwear plays an essential role in preventing diabetic foot complications. In many Asian countries, including Indonesia, sandals are commonly used because of climatic, cultural, and socioeconomic factors. However, most commercially available sandals are not designed to meet the therapeutic requirements needed to protect diabetic feet. Although wound care nurses play a crucial role in diabetic foot prevention and patient education, the perspectives of both nurses and patients regarding the design of diabetic foot sandals remain insufficiently explored.
Objective:
This study aimed to explore the perspectives of wound care nurses and patients regarding the structural and functional design of diabetic foot sandals in Indonesia.
Methods:
A descriptive qualitative study was conducted in two phases: eliciting expert perspectives and validating user needs. Wound care nurses were recruited using total sampling during a national wound care forum and completed open-ended questionnaires. Patients with diabetic foot ulcers without gangrene were purposively recruited from two wound care clinics in eastern Indonesia and participated in face-to-face interviews following a brief walking trial using a prototype diabetic sandal. Data were documented using field notes and analyzed thematically to identify perceptions related to the structural and functional design of diabetic foot sandals.
Results:
A total of 93 wound care nurses and 11 patients with DFUs participated in the study. Nurses emphasized the importance of soft and durable materials, pressure-distributing insoles, adjustable straps, stable sole structures, and protective sandal designs. Functional considerations included comfort, safety, ease of use, and support for daily activities. The patients highlighted the importance of lightweight design, adequate width, open or semi-open structures, and walking comfort. Both groups also emphasized affordability, practicality, and usability as important aspects of diabetic sandal design, although some differences were observed in structural and model preferences.
Conclusions:
The perspectives of wound care nurses and patients highlight both shared priorities and complementary insights in the design of diabetic foot sandals. Integrating clinical safety, functional usability, cultural suitability, and affordability is essential for developing contextually appropriate diabetic footwear for people with diabetes in Indonesia. Clinical Trial: Not Applicable
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