Translation and Validation of the Indonesian Version of the Diabetic Foot Ulcer Scale–Short Form (DFS-SF): A Psychometric Evaluation
DOI:
https://doi.org/10.31674/mjn.2026.v17i04.001Abstract
Background: Diabetic Foot Ulcer (DFU) is a common chronic complication of diabetes that significantly impairs patients’ quality of life. However, a culturally adapted and validated Indonesian DFU specific quality of life instrument to support comprehensive nursing assessment is not yet available. Objective: This study aimed to adapt the DFS-SF (Diabetic Foot Ulcer Scale) into Indonesian using a standardized translation process and to evaluate its psychometric properties, specifically validity and reliability. Methods: This study used a cross-sectional quantitative design and recruited 118 patients from three urban wound care clinics. The original DFS-SF underwent forward-backward translation and cultural adaptation. Internal consistency and construct validity were examined using PLS-SEM (Partial Least Squares Structural Equation Modeling) analysis. Results: The Indonesian DFS-SF demonstrated robust psychometric properties, including high reliability and validity across all domains. Strong internal consistency was observed across all domains, with both Cronbach’s alpha and composite reliability > 0.80. The construct demonstrated adequate convergent validity, evidenced by Average Variance Extracted (AVE) values of 0.60 or higher, and by employing the Fornell-Larcker criterion, discriminant validity was verified. Outer loadings for most indicators were above 0.70, with particularly high loadings for Leisure (≥0.95) and daily activity (≥0.91) domains, indicating robust construct measurement. Conclusion: The Indonesian version demonstrated validity and reliability for assessing quality of life in patients with DFU. To enhance generalizability, future studies should include more diverse populations. This research suggests that the Indonesian version of the DFS-SF can be effectively applied in clinical settings to assess the quality of life among patients with diabetic foot ulcers.
Keywords:
Diabetic Foot; , Psychometrics; , Quality of Life; , TranslationDownloads
References
Abetz, L., Sutton, M., Brady, L., McNulty, P., & Gagnon, D. D. (2002). The Diabetic Foot Ulcer Scale (DFS): a quality of life instrument for use in clinical trials. Practical Diabetes International, 19(6), 167-175. https://doi.org/10.1002/pdi.356
Alasfour, L., Alboloushi, A., Kirwan, E., McIntosh, C., MacGilchrist, C., & Hurst, J. E. (2025). Mapping the evidence to determine the influence of stress, anxiety, and depression on wound healing in patients with diabetes-related foot ulcers: A Scoping Review. Journal of Tissue Viability, 100935. https://doi.org/10.1016/j.jtv.2025.100935
Álvaro-Afonso, F. J., García-Madrid, M., García-Morales, E., López-Moral, M., Molines-Barroso, R. J., & Lázaro-Martínez, J. L. (2024). Health-related quality of life among Spanish patients with diabetic foot ulcer according to Diabetic Foot Ulcer Scale–Short Form. Journal of Tissue Viability, 33(1), 5-10. https://doi.org/10.1016/j.jtv.2023.11.011
Amato, E., Giangreco, F., Iacopi, E., & Piaggesi, A. (2025). Patient-Reported Experience (PREMs) and Outcome (PROMs) Measures in Diabetic Foot Disease Management—A Scoping Review. Journal of Clinical Medicine, 14(17), 6116. https://doi.org/10.3390/jcm14176116
Bann, C. M., Fehnel, S. E., & Gagnon, D. D. (2003). Development and validation of the Diabetic Foot Ulcer Scale-short form (DFS-SF). Pharmacoeconomics, 21(17), 1277-1290. https://doi.org/10.2165/00019053-200321170-00004
Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186-3191. https://doi.org/10.1097/00007632-200012150-00014
Byrnes, J., Ward, L., Jensen, S., Sagoo, M., Charles, D., Mann, R., ... & Lazzarini, P. A. (2024). Health-related quality of life in people with different diabetes-related foot ulcer health states: A cross-sectional study of healed, non-infected, infected, hospitalised and amputated ulcer states. Diabetes Research and Clinical Practice, 207, 111061. https://doi.org/10.1016/j.diabres.2023.111061
Chen, L., Cheng, L., Gao, W., Chen, D., Wang, C., & Ran, X. (2020). Telemedicine in chronic wound management: systematic review and meta-analysis. JMIR mHealth and uHealth, 8(6), e15574. https://doi.org/10.2196/15574
Crews, R. T., Schneider, K. L., Yalla, S. V., Reeves, N. D., & Vileikyte, L. (2016). Physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers: a critical review. Diabetes/Metabolism Research and Reviews, 32(8), 791-804. https://doi.org/10.1002/dmrr.2817
Crocker, R. M., Palmer, K. N., Marrero, D. G., & Tan, T. W. (2021). Patient perspectives on the physical, psycho-social, and financial impacts of diabetic foot ulceration and amputation. Journal of Diabetes and its Complications, 35(8), 107960. https://doi.org/10.1016/j.jdiacomp.2021.107960
Ghadeer, A., Yan, T., Claire, M., Ellen, K., Caroline, M., & McIlwaine, A. (2025). Diabetic foot ulcer related pain and its impact on health-related quality of life. Journal of Tissue Viability, 34(2), 100856. https://doi.org/10.1016/j.jtv.2025.100856
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2019). Multivariate data analysis (8th ed.). In Annabel Ainscow Annabel Ainscow. https://eli.johogo.com/Class/CCU/SEM/_Multivariate%20Data%20Analysis_Hair.pdf
Hariftyani, A. S., Novida, H., & Edward, M. (2021). Profile of diabetic foot ulcer patients at tertiary care hospital in Surabaya, Indonesia. Jurnal Berkala Epidemiologi, 9(3), 293-302. https://doi.org/10.20473/jbe.V9I32021.293-302
Haryanto, H., Makmuriana, L., Hartono, H., Arini, D. D., Ariyanti, S., Sari, Y., ... & Ervita, L. (2023). Quality of life in patients with recurrent diabetic foot ulcers. Central European Journal of Nursing and Midwifery, 14(1), 833. https://doi.org/10.15452/cejnm.2022.13.0025
Hogg, F. R. A., Peach, G., Price, P., Thompson, M. M., & Hinchliffe, R. J. (2012). Measures of health-related quality of life in diabetes-related foot disease: A systematic review. Diabetologia, 55(3), 552-565. https://doi.org/10.1007/s00125-011-2372-5
Hu, X., Zhao, Z., Zhang, S. K., Luo, Y., Yu, H., & Zhang, Y. (2020). CA-PROM: validation of a general patient-reported outcomes measure for Chinese patients with cancer. Cancer Epidemiology, 67, 101774. https://doi.org/10.1016/j.canep.2020.101774
Lee, Y. N. (2019). Translation and validation of the Korean version of the diabetic foot ulcer scale‐short form. International Wound Journal, 16, 3-12. https://doi.org/10.1111/iwj.13025
Macioch, T., Sobol, E., Krakowiecki, A., Mrozikiewicz-Rakowska, B., Kasprowicz, M., & Hermanowski, T. (2017). Health related quality of life in patients with diabetic foot ulceration—translation and Polish adaptation of Diabetic Foot Ulcer Scale short form. Health and Quality of Life Outcomes, 15(1), 15. https://doi.org/10.1186/s12955-017-0587-y
Martinez-Gonzalez, D., Dòria, M., Martínez-Alonso, M., Alcubierre, N., Valls, J., Verdú-Soriano, J., ... & Mauricio, D. (2020). Adaptation and validation of the diabetic foot ulcer scale-short form in Spanish subjects. Journal of Clinical Medicine, 9(8), 2497. https://doi.org/10.3390/jcm9082497
Mokkink, L. B., Terwee, C. B., Patrick, D. L., Alonso, J., Stratford, P. W., Knol, D. L., Bouter, L. M., & de Vet, H. C. W. (2010). The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. Journal of Clinical Epidemiology, 63(7), 737–745. https://doi.org/10.1016/j.jclinepi.2010.02.006
Ojo, O., Boateng, J., Pacella, R., Hanrahan, A., Essex, R., & Dibley, L. (2025). Factors influencing the care and management of diabetic foot ulcers: A scoping review. Endocrine Practice, 31(3), 380-389. https://doi.org/10.1016/j.eprac.2024.11.010
Paixão, L. O., Zanchetta, F. C., de Aquino Pereira, J., Kaizer, U. A. O., Bramante, C. M., Apolinario, P. P., ... & Melo Lima, M. H. (2025). Factors associations and with health-related quality of life in individuals with diabetic foot ulcers: Cross-sectional study. Journal of Wound Management, 26(1), 22-28. https://doi.org/10.35279/jowm2025.26.01.07
Pouwer, F., Mizokami-Stout, K., Reeves, N. D., Pop-Busui, R., Tesfaye, S., Boulton, A. J., & Vileikyte, L. (2024). Psychosocial care for people with diabetic neuropathy: time for action. Diabetes Care, 47(1), 17-25. https://doi.org/10.2337/dci23-0033
Raju, B. N., Mateti, U. V., Mohan, R., D'Souza, C., Shastry, C. S., & D'Souza, N. (2022). Transcultural adaptation of the Malayalam version of the diabetic foot ulcer scale-short form. Clinical Epidemiology and Global Health, 18, 101190. https://doi.org/10.1016/j.cegh.2022.101190
Russo, S., Landi, S., & Simoni, S. (2025). Cost-effectiveness analysis for managing diabetic foot ulcer (DFU) in USA: Platelet-rich plasma (PRP) vs standard of care (SoC). ClinicoEconomics and Outcomes Research, 157-169. https://doi.org/10.2147/CEOR.S496616
Rusu, A., Roman, G., Stancu, B., & Bala, C. (2025). The Burden of Diabetic Foot Ulcers on Hospital Admissions and Costs in Romania. Journal of Clinical Medicine, 14(4), 1248. https://doi.org/10.3390/jcm14041248
Sobol, E., Macioch, T., Krakowiecki, A., Mrozikiewicz-Rakowska, B., Kasprowicz, M., & Hermanowski, T. R. (2015). Translation and validation of the polish diabetic foot ulcer scale-short form (DFS-SF). Value in Health, 18(7), A615-A616. https://doi.org/10.1016/j.jval.2015.09.2143
Steptoe, A., Deaton, A., & Stone, A. A. (2015). Subjective wellbeing, health, and ageing. The Lancet, 385(9968), 640-648. https://doi.org/10.1016/S0140-6736(13)61489-0
Swaminathan, N., Awuah, W. A., Bharadwaj, H. R., Roy, S., Ferreira, T., Adebusoye, F. T., ... & Papadakis, M. (2024). Early intervention and care for diabetic foot ulcers in low and middle income countries: Addressing challenges and exploring future strategies: A narrative review. Health Science Reports, 7(5), e2075. https://doi.org/10.1002/hsr2.2075
Van Leeuwen, K. M., Van Loon, M. S., Van Nes, F. A., Bosmans, J. E., De Vet, H. C., Ket, J. C., ... & Ostelo, R. W. (2019). What does quality of life mean to older adults? A thematic synthesis. PloS One, 14(3), e0213263. https://doi.org/10.1371/journal.pone.0213263
World Health Organization (WHO). (2012). WHOQOL User Manual Programme on Mental Health Division of Mental Health and Prevention of Substance Abuse World Health Organization. https://iris.who.int/handle/10665/77932#sthash.jCXbuNFW.dpuf
Yunir, E., Hidayah, C. D., Harimurti, K., & Kshanti, I. A. M. (2022). Three years survival and factor predicting amputation or mortality in patients with high risk for diabetic foot ulcer in Fatmawati General Hospital, Jakarta. Journal of Primary Care & Community Health, 13, 21501319211063707. https://doi.org/10.1177/21501319211063707
Zhang, P., Lu, J., Jing, Y., Tang, S., Zhu, D., & Bi, Y. (2017). Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Annals of Medicine, 49(2), 106-116. https://doi.org/10.1080/07853890.2016.1231932
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 The Malaysian Journal of Nursing (MJN)

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.



































