Publication Date
Winter 3-11-2026
Document Type
Article
Executive Summary
The Impact of Foot Care Education Within the Unhoused Female Population: A Community-based Nursing Intervention
The unhoused population is a vulnerable community that faces many obstacles in accessing healthcare (Benadda et al., 2025). Many of these individuals face stigmas related to their economic and housing conditions. It is important for nurses to be able to identify risk factors that may increase the prevalence of health-related problems, including using public health models to implement disease prevention. When discussing this population, one crucial preventative measure includes foot care, which aids in the deterrence of infections and promotes overall health (Coates et al., 2020). The purpose of this paper is to provide a summary of a community-based project, led by nursing students, to address foot care education within the unhoused female population. This project was conducted at a women’s day center in Seattle, Washington, that serves unhoused individuals.
Background
A windshield survey highlighted an issue regarding the foot health status of unhoused women. Kaye (2022) found that about two-thirds of the unhoused population have a foot-related health condition. This is especially prevalent in areas with high moisture and humidity, such as Seattle (Christensen, 2024). Addressing concerns related to foot health is important to reduce the prevalence of the problem. Unhoused women are all at risk of developing foot disease that can lead to pain, infection, and unsteady gait – all of which can lead to permanent damage – due to their housing status (Benadda, 2025). Educating the unhoused population on foot care is important for public health nursing to help treat and prevent permanent damage that would lower the quality of life for each person. When resources are limited, it is important to ensure that unhoused women have proper foot care knowledge, so they have the best chance of not developing or worsening their foot health.
The identified nursing diagnosis is that unhoused women are at risk of impaired skin integrity and infection related to a lack of foot care, limited resources, and a foot care knowledge deficit. Foot care education was planned for the women to help prevent foot diseases and provide resources on what to look for regarding foot disease and how to get help. The transtheoretical model guided the project development to see where in the stages of change each participant was, and where they would be after getting educated on foot care. This model is useful for this type of education intervention because it highlights that change in one’s behavior is a process, and different people are in different stages of change and readiness (Hashemzadeh et al., 2019). This model has five stages: precontemplation, contemplation, preparation, action, and maintenance.
Prior studies that implemented preventive foot care in the unhoused population showed a decrease in foot wounds and diseases. For instance, Benadda et al. (2025) found that self-foot exams, appropriate footwear that utilizes socks, and education are crucial in preventing and detecting foot disease. It was also anticipated that educating them on the use of clean socks in their foot care routine would help prevent the start or worsening of an injury or infection. Clean socks are one of the most important pieces of preventive foot care because they protect individuals’ feet from inadequately fitting footwear (Rasul & Bergholz, 2022). By keeping socks dry, one also minimizes the risk of creating an infection-prone environment.
Activities
The women at the day center faced barriers in access to resources and evidence-based education on proper foot care. Based on an informal assessment, it was determined that most women do not receive proper education on how to care for their feet. Different barriers to access were found, such as altered mental health, mobility limitations, and a lack of supplies. Some experienced fear of leaving the day center due to past traumas, agoraphobia, and fear of safety. This, in turn, limits women from seeking healthcare assistance.
Several interventions were implemented to address the nursing diagnosis. First, an educational foot care pamphlet was created to demonstrate how to wash and care for one’s feet. This contained a group-created video, pictures, and a step-by-step guide. Instructions included when to seek care when identifying a wound or disease on the foot along with the most common problems experienced in the unhoused population: athlete’s foot, plantar warts, and open wounds (Coates et al., 2020). One-on-one education was provided in-person at the day center to help simplify foot care education using the pamphlet, which could be kept as a physical tool that can be referred to in the future. Along with the pamphlet, pre- and post-surveys were created to help evaluate the effect of education on knowledge and intent of foot self-care. To incentivize education and surveys, foot care kits were created that included a pedicure kit (a nail file, foot brush, nail buffer, and an orangewood stick), nail polish, moisturizer, and a pair of socks. The foot care kit was made not purely for incentive, but also as a resource for the women to have the basic supplies for foot care.
Outcomes
Fourteen women participated in the surveys and foot care education. Participants rated their confidence and knowledge of foot care before getting the intervention. The women then received verbal, visual, and physical education, along with the foot care kit. The participants were free to ask any questions while receiving education, and the teach-back method was utilized. Lastly, the residents filled out the post-survey. This allowed for an evaluation of their readiness to change their foot care habits by examining their answers to the survey questions. A comparison of pre- and post-survey data showed an increase in confidence and knowledge of foot care in all fourteen participants. The women also answered that they will increase the number of times they perform their own foot care, including increasing the number of times they wash their feet, check for wounds, and change their socks. Using the transtheoretical model and evaluating the surveys, it was found that most of the fourteen women were in the contemplation and planning stages, which is optimal for receiving education on lifestyle changes (Hashemzadeh et al., 2019). To support sustainability, extra pamphlets, supplies, and an online resource were left for staff to continue implementing and share with interested individuals.
Conclusion
Unhoused individuals encounter healthcare barriers that present a risk to foot health, which leads to an increased risk of impaired skin integrity and infection. Participating women reported an increase in understanding why foot care is important, along with a readiness to change behavioral habits to enhance their foot care. To maintain sustainability in the project, brochures and kits were left at the shelter as a resource for staff to provide to women. Before the COVID-19 pandemic, the day center provided foot care where they would focus on washing feet and trimming nails, which was something the women valued. Due to an absence of supplies and funding, foot care could not be implemented during this project period. However, the educational materials and results of this project can provide a strong foundation for future groups collaborating with this day center to improve foot health.
References
Benadda, I., Lozano-Franco, R., Coutu, F.-A., Wells, S., Ades, M., Nauche, B., & Drudi, L. M. (2025). A preliminary assessment of barriers and facilitators to accessing foot care in homeless shelters: A scoping review. Annals of Vascular Surgery, 111, 279-289. https://doi.org/10.1016/j.avsg.2024.10.026
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Coates, S. J., Amerson, E. H., & Chang, A. Y. (2020). Dermatologic care of persons experiencing homelessness: Key concepts in an era of housing instability. JAMA Dermatology, 156(9), 945–946. https://doi.org/10.1001/jamadermatol.2020.0902
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Kaye, A. (2022). The affects of the foot conditions on the homeless population (thesis). University of Central Florida. https://stars.library.ucf.edu/cgi/viewcontent.cgi?article=2260&context=honorstheses
Rasul, T. & Bergholz, D. (2022). Foot Health Needs Assessment. Miami Street Team. https://www.miamistreetmedicine.org/post/foot-health-needs-assessment
Tanji, M. H. (2021, August). Foot screening education and tool to increase foot exams for the homeless. Scholar Space. https://scholarspace.manoa.hawaii.edu/server/api/core/bitstreams/ba3e4b4b-9d6f-4490-a931-4435ce1c59c3/content
Recommended Citation
Coronel Barragan, Bertha Karina; Sandoval, Jessica; Darko, Afia Margaret; Lucero, Alexandra Elizabeth; Kim, Gloria Yeyoung; and Ziegler, Anyanka T., "The Impact of Foot Care Education Within the Unhoused Female Population: A Community-based Nursing Intervention" (2026). Nursing Leadership in Community Engagement Projects. 69.
https://digitalcommons.spu.edu/shs_nlce/69
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