Foot Screening Education and Tool to Increase Foot Exams for the Homeless

Abstract

Comprehensive foot exams are essential assessments for those with cardiovascular and endocrine disorders. The performance of this type of screening can help to detect lower extremity disorders, thereby preventing long-term complications like infections and amputations. Homeless persons in Hawai’i are highly susceptible to lower extremity disorders due to unknown disease status, poor lifestyle, and harsh environment. They rely on their feet for survival and would benefit from having this assessment to sustain mobility and quality of life. The Hawai’i Homeless Outreach and Medical Education (HOME) project, a mobile-based clinic managed by the University of Hawaii John A. Burns School of Medicine, was ideal for providing this service. The purpose of this evidence-based quality improvement project was to provide training on how to do comprehensive foot exams to the medical students who performed patient assessments. The training was delivered via PowerPoint and was supplemented with a foot exam ID tool for portable use. Data was collected from pre-training and exit surveys to assess knowledge of comprehensive foot exams and the use of the tool. The results showed a 29.86% increase in students performing this exam and a significant shift in proficiency before training compared to after. Also, 94.4% of students taking the exit survey were able to name at least one component of the exam, and 70.0% were able to name all the exam components. Of these students, 73.3% claimed the tool helped them identify issues they would have overlooked, and all would recommend the tool for future rotating students. Lastly, 95% said the training was helpful. In conclusion, the project showed positive results and gave evidence for training continuation. Though limitations were found regarding project setting and personnel delivering the training, it was established that the training is essential to this population and should be available for future rotations at the HOME clinic.