Publication Date
Spring 5-27-2026
Document Type
Instructional Material
Executive Summary
As housing instability and homelessness increase in King County, many basic needs, including foot care, are often unmet. According to a study on foot health among vulnerable populations, individuals may be unable to perform proper foot care due to prioritization of basic daily needs over preventative care (Razmus, 2023). Research indicates that foot-related complications are highly prevalent among vulnerable populations and may worsen without timely intervention (Haughton et al., 2026). Barriers such as fear of stigmatization and untreated mental health conditions can also limit access to healthcare services (Kimball et al., 2023). These statistics inspired the purpose of this community health project, which was conducted by our nursing student team in partnership with a local agency.
Background
The agency site we collaborated with in Washington state serves approximately 50–100 individuals daily, many of whom are in various stages of recovery from substance use or behavioral addictions (Personal communication, April 1, 2026). To better understand community needs, our team conducted a windshield survey, informal interviews, and a needs assessment.
The windshield survey showed that the area is primarily commercial with limited visible community support resources. Interviews revealed common challenges including frequent relocation, walking as the main form of transportation, chronic health conditions, psychosocial stressors, financial strain, low motivation, and limited health literacy. These factors can make consistent foot care difficult. Vulnerable populations are at increased risk for health disparities related to socioeconomic and psychosocial factors (Ernstmeyer & Christman, 2022).
During the needs assessment, participants identified commonly needed items such as socks, shoes, and lotion, as well as a desire for additional foot care education. Based on these findings, a community health project was developed to provide foot care hygiene education and increase awareness of available resources within the agency and community. The project aimed to improve knowledge and promote preventative foot care practices among individuals recovering from addiction.
Activities with rationale
An educational pamphlet was used during one-on-one teaching sessions to address common concerns within this population. Concerns include, the importance of foot care, recognition of signs and symptoms of skin and foot complications, supportive messaging, and guidance on topics to discuss with a healthcare provider. The teach-back method was also used to confirm understanding and reinforce learning in their own interpretation, which is an effective way of communication (Mahmoodi, 2025).[IJ1] This intervention was important because limited access to healthcare education and resources may increase the risk of preventable foot complications within this population.
During implementation, we divided responsibilities among team members to support both the educational intervention and the donation powered shopping for members taking place at the local community agency. Team members conducted pre- and post-surveys to assess participants’ knowledge, confidence around foot care, and willingness to engage in healthy foot care practices. The post-survey was conducted after we went over the pamphlet one-on-one. We donated 40 goodie bags with nail clippers, lotion, nail files, and wet wipes to provide a starting kit for the members at the agency and put their newfound education to use with the proper tools.
Outcomes
Both the pre- and post- surveys were conducted with the same 27 participants. Before our educational intervention, more than half reported checking their feet daily, and almost 40% were hesitant to seek medical care from a provider or clinic. Participants emphasized barriers to foot care, consisting of pain, lack of clean socks or shoes, limited access to hygiene resources, and low motivation. After the educational intervention using the teach-back method, post-survey responses showed improved understanding of foot complications to monitor. After the educational intervention, participants demonstrated a 100% increase in confidence in discussing foot care concerns with a healthcare provider and a 71% increase in confidence with independently managing their own foot care.
Sustainability and Limitations
One of the strengths of this project was its focus on a vulnerable and underserved population with significant unmet health needs related to foot care. The intervention was practical, accessible, and prevention-focused, allowing participants to receive education that could be immediately incorporated into their daily lives. Another strength was the use of multiple community assessment methods, which helped ensure the intervention was tailored to the specific needs of the population served. Lastly, the project added to existing resources provided by the agency, such as the shopping day, where members were able to get well-fitting shoes and sock, while also helping members recognize early signs of foot problems and to know when to seek further care from provider or connecting with the agency's monthly foot care service.
One limitation of this project was the inability to provide direct foot care services due to limited supplies and funding. Additionally, the project was conducted over a short period which limited opportunities for repeated educational sessions and reinforcement of learning that could support long-term retention and application of proper foot care practices. However, the project achieved a strong participation rate with surveys collected from 27 participants, which represents approximately one-third of the members who were at the site. This level of participation provided meaningful feedback and valuable data for our project. Overall, the feedback and survey results demonstrated increased knowledge and confidence in foot care, indicating that the intervention was successful.
If this project were to be repeated, several improvements could enhance both the effectiveness and sustainability of the intervention. After the intervention being successful, it could be expanded to a larger number of participants. Increased funding and additional supplies would allow for the inclusion of direct foot care services alongside education. Extending the project timeline would also provide opportunities for follow-up visits and reinforcement of education content.
Conclusion
Foot care is an essential component of overall health, comfort, and quality of life, particularly for individuals experiencing housing instability and addiction recovery. Without proper foot care, individuals can suffer from a range of conditions, from acute injuries to chronic disease. The project demonstrated that addressing knowledge deficits in foot care led to increased awareness and improved participants’ confidence in practicing and promoting proper foot care. This experience provided valuable insight into the needs and experiences of this vulnerable population and reinforced key aspects of nursing practice, including advocacy, education, and the importance of serving individuals across diverse communities.
Ernstmeyer, K., & Christman, E. (2022). Nursing: Mental health and community concepts. In www.ncbi.nlm.nih.gov. Chippewa Valley Technical College. https://www.ncbi.nlm.nih.gov/books/NBK590046/
Haughton, R., Cheb, D., Herbert, S., Shiboski, S., Yazdany J., Chang, A.Y. (2026).
Dermatological diagnoses among people experiencing homelessness in the USA. Skin Health and Disease, 6(2), 103-111. https://doi.org/10.1093/skinhd/vzaf095
Ju, H.H., Ottosen, M., Alford, J., Jularbal, J., Johnson, C. (2024, Feburary 8). Enhancing foot care education and support strategies in adults with type 2 diabetes. National Library of Medicine. 36(6):334–341. doi: 10.1097/JXX.0000000000000998
Kimball, K. M., Cowan, R. A., Krevh, R., Nicholson, A., Shah, P., Shreya Gurumurthy, & Graham, J. (2023). Skincare from the inside out: a pilot project addressing social determinants of health through dermatology. International Journal of Women’s Dermatology, 9(3), e094–e094. https://doi.org/10.1097/jw9.0000000000000094
Li, C., Nusynowitz, J., Gessner, N., Strahan, A. G., Trinidad, J. C., & Coates, S. J. (2026). A practical guide to improve dermatologic care for people experiencing homelessness. Journal of Investigative Dermatology. https://doi.org/10.1016/j.jid.2026.02.018
Mahoui, A., Kay, J., Yazdanzy, J., Chang, A. (2024). Dermatologic hospitalizations among
unhoused patients across three states. Journal of Investigative Dermatology. 144(8). 10.1016/j.jid.2024.06.527 External Link
Mahmoodi H. (2025). Empowering patients through effective communication: The teach-back method as a tool for health literacy. Health promotion perspectives, 15(3), 211–212. https://doi.org/10.34172/hpp.025.44214
NIH News in Health. (2023, February 28). Focus on your feet! NIH News in Health. https://newsinhealth.nih.gov/2023/03/focus-your-feet
Our mission. (2026). Recovery Café. https://recoverycafe.org/about/mission/
Razmus, I. (2023). Foot Health Among Vulnerable Populations: Reflections on a Recent Study. WoundSource. https://www.woundsource.com/blog/foot-health-among-vulnerable-populations-reflections-recent-study
Yanes, Marcy, "Care in a bag: Supporting Unhoused Individuals" (2025). Capstone Projects and Master' s Theses. 2036. https://digitalcommons.csumb.edu/caps_thes_all/2036
Recommended Citation
Frahm, Erika; Goodrow, Kayla; Hofmaister, Zoe; Inouye, Jaycie; Katori, Shuma; Maza, Caleb James; and Tomno, Fauzia, "Promoting foot care health in individuals recovering from addiction: A collaborative and community-based nursing intervention" (2026). Nursing Leadership in Community Engagement Projects. 73.
https://digitalcommons.spu.edu/shs_nlce/73
Copyright Status
http://rightsstatements.org/vocab/InC/1.0/
Additional Rights Information
Copyright held by authors, except where otherwise noted.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Included in
