Evaluation of Cyberchondria, E-Health Literacy, and Psychological Status in Patients with Diabetic Foot Ulcers: A Pilot Study
Keywords:
Anxiety Disorders, Cyberchondria, Diabetes Mellitus, Diabetic Foot, Health LiteracyAbstract
Purpose: This study was designed to assess the levels of cyberchondria, e-health literacy, and psychological status in patients with diabetic foot ulcers (DFUs).
Methods: This pilot study involved 33 participants aged 18 years and older who had a diagnosis of DFU for a minimum duration of three months, with sociodemographic and clinical information obtained through a structured questionnaire. Sociodemographic and clinical data were collected via a structured questionnaire. Participants completed the Cyberchondria Severity Scale (CSS), E-Health Literacy Scale, and Depression Anxiety Stress Scale-21 (DASS-21). Descriptive statistics will be used in the evaluation of the data.
Results: The mean age of the participants was 55.48±14.95 years, and the majority were male (81.8%). Participants’ cyberchondria levels were low across all subscales and eHealth literacy scores were low (11.39±9.00). Their psychological symptom levels were moderate based on their DASS-21 total score (15.82±11.84). Most participants reported little or no internet use, with 69.7% reporting never searching online for health information. Furthermore, 93.9% did not follow any health-related social media platforms and would not recommend online health research to others.
Conclusion: Patients with DFUs exhibited low levels of cyberchondria and e-health literacy, and moderate levels of depression, anxiety, and stress. Low internet use, older age, male dominance, and low educational background may contribute to these findings. Despite the growing digitalization in healthcare, this population may face significant barriers in accessing and utilizing reliable online health information. Multidisciplinary DFU care should incorporate not only medical treatment but also psychological support and digital health literacy education.
References
1. Zhou S, Hu X, Wang Y, Fei W, Sheng Y, Que H. The Global Prevalence of Methicillin-Resistant Staphylococcus Aureus in Patients with Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis. Diabetes Metab Syndr Obes. 2024;17:563-74.
2. Deng H, Li B, Shen Q, Zhang C, Kuang L, Chen R,et al. Mechanisms of diabetic foot ulceration: A review. J Diabetes. 2023;15(4):299-312.
3. Ndosi M, Wright-Hughes A, Brown S, Backhouse M, Lipsky BA, Bhogal M, et al. Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study. Diabet Med. 2018;35(1):78-88.
4. Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017 Jun 15;376(24):2367-75.
5. Janzen Claude JA, Hadjistavropoulos HD, Friesen L. Exploration of health anxiety among individuals with diabetes: prevalence and implications. J Health Psychol. 2014;19(2):312-22.
6. Demir, Y., Dağ, E., Özpınar, S. The Relationship of E-health Literacy with Cyberchondria: A Cross-Sectional Study on Pregnant Women. J Health Lit. 2024;9(1): 89-101.
7. Xu RH, Starcevic V. Cyberchondria in Older Adults and Its Relationship With Cognitive Fusion, Health-Related Quality of Life, and Mental Well-Being: Mediation Analysis. JMIR Aging. 2025;8:e70302.
8. McElroy E, Shevlin M. The development and initial validation of the cyberchondria severity scale (CSS). J Anxiety Disord. 2014;28(2):259-65.
9. Norman CD, Skinner HA. eHealth Literacy: Essential Skills for Consumer Health in a Networked World. J Med Internet Res. 2006;8(2):e9.
10. Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005;44(Pt 2):227-39.
11. Türedi MG, Albayrak Coşar A. Diyabet Hastalarında Sağlık Kaygısının Siberkondri Düzeylerine Etkisi: Bir Eğitim ve Araştırma Hastanesi Örneği. Turk J Diab Obes. 2025;9(1):48-60.
12. Erdoğan Z, Demirel U, Ceylan G. Determining E-Health Literacy, Cyberchondria, and Affecting Factors in Cancer Patients: A Cross-sectional Study. Comput Inform Nurs. 2025;43(6):e01303.
13. Güzel S, Özer Z. Cyberchondria levels and affecting factors in heart patients. Turk J Cardiovasc Nurs. 2021;12(27):36-46.
14. Sahan HF, Uslu-Sahan F, Sahin B. Predictors of Illness Behavior in Turkish Women with Cardiovascular Disease: The Role of Health Anxiety and Cyberchondria. J Clin Psychol Med Settings. 2025. doi: 10.1007/s10880-025-10071-7.
15. Vismara M, Benatti B, Ferrara L, Colombo A, Bosi M, Varinelli A, et al. A preliminary investigation of Cyberchondria and its correlates in a clinical sample of patients with obsessive-compulsive disorder, anxiety and depressive disorders attending a tertiary psychiatric clinic. Int J Psychiatry Clin Pract. 2022;26(2):111-22.
16. Bahadır, E. (2021). Çevrimiçi sağlık arama davranışı (siberkondri) üzerine bir gözden geçirme. J Clin Psychol. 2021;5(1):79-85.
17. Kobryn M, Duplaga M. Does Health Literacy Protect Against Cyberchondria: A Cross-Sectional Study? Telemed J E Health. 2024;30(4):e1089-e1100.
18. Mansur F, Ciğerci K. Siberkondri ve E-Sağlık Okuryazarlığı Arasındaki İlişki. Gümüşhane Sağlık Bilimleri Dergisi. 2022;11(1):11-2.
19. Santoro G, Starcevic V, Scalone A, Cavallo J, Musetti A, Schimmenti A. The Doctor Is In(ternet): The Mediating Role of Health Anxiety in the Relationship between Somatic Symptoms and Cyberchondria. J Pers Med. 2022;12(9):1490.
20. Yorulmaz M, Göde A, Aydoğdu A, Dilekçi R. Investigation of the effect of internet addiction on cyberchondria. Psychol Health Med. 2025;30(6):1187–98.
21. Deniz S. Bireylerin E-Sağlık Okuryazarlığı ve Siberkondri Düzeylerinin İncelenmesi. İnsan ve İnsan Dergisi. 2020;7(24):84-96.
22. Göde A, Öztürk YE. Üniversite öğrencilerinin siberkondri düzeylerinin sağlik kaygisi üzerine etkisinin incelenmesi. Selçuk Sağlık Dergisi, 2023;4(Kongre Özel):1-17.
23. Starcevic V, Berle D. Cyberchondria: towards a better understanding of excessive health-related Internet use. Expert Rev Neurother. 2013;13(2):205-13.
24. Kazgan Kılıçaslan A, Yıldız S, Gür C, Uğur K. Cyberchondria and health anxiety in patients with fibromyalgia. Arch Psychiatry Psychother. 2022;24(4):16-25.
25. Avsar A, Kilincarslan MG, Yilmaz TE, Sari O. Health literacy and its impact on diabetic foot knowledge, self-care and ulcer outcomes. Euras J Fam Med. 2025;14(2):39-49.
26. Sousa ÁAD, Brito AMG, Fasolak SA. Health literacy regarding diabetic foot and associated factors in individuals with type 1 and type 2 diabetes assisted by primary health care. Rev Med. 2024;103(5):225802. http://dx.doi.org/10.11606/issn.1679-9836.v103i5e-225802
27. Elnaem MH, Bukhori NAS, Tengku Mohd Kamil TK, Rahayu S, Ramatillah DL, Elrggal ME. Depression and anxiety in patients with type 2 diabetes in Indonesia and Malaysia: do age, diabetes duration, foot ulcers, and prescribed medication play a role? Psychol Health Med. 2025;30(3):555-71.
28. Jiang FH, Liu XM, Yu HR, Qian Y, Chen HL. The Incidence of Depression in Patients With Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis. Int J Low Extrem Wounds. 2022;21(2):161-73.
29. Pereira MG, Pedras S, Louro A, Lopes A, Vilaça M. Stress reduction interventions for patients with chronic diabetic foot ulcers: a qualitative study into patients and caregivers' perceptions. J Foot Ankle Res. 2023;16(1):3.
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