The aim of this observational study is to: (1) describe current knowledge and practices related to foot care in care homes; (2) understand how care home staff, residents and/or family caregivers perceive foot care knowledge and practices. For the first study, the investigators are conducting a survey, and this will involve recruiting care staff working in care homes, managers of care homes, and staff in regular contact with care home residents (e.g. clinicians). The second study will involve interviews with care home staff (carers, care home managers and health professionals) and care home residents and/or their family representative.

Around 430,000 older adults live in care homes in England, and many are living with long-term health conditions like diabetes and heart disease. Foot problems are also very common and affect one in four. Care home staff have an important role in the early detection and prevention of foot problems but have no training in foot care. The aim of this study is to: (1) describe current knowledge and practices related to foot care in care homes; (2) understand how care home staf, residents and/or family caregivers perceive foot care knowledge and practices. This work will help to establish how care staff can be supported to develop new knowledge in foot care. This project will involve two linked studies. For the first study, an England-wide electronic survey will be conducted, and this will involve recruiting care staff working in care homes, managers of care homes, and staff in regular contact with care home residents. The second study will involve interviews with care home staff (carers, care home managers and health professionals) and care home residents and/or family members. Data collection for the first study will involve completion of an online survey. The second study will involve interviews, which will be conducted online and/or in the care home. The study will last for 18 months. For the survey, care home staff will participate via an electronic device (such on a laptop or smartphone). The interview study will involve one-to-one interviews, and these will be conducted in person, or online.

The study is funded by the National Institute for Health and Care Research (NIHR) [Programme Development Grant (NIHR502941)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Inclusion Criteria:

Task 1 National Survey

• Care staff working in residential care home settings. Care staff will have responsibility for the personal care of residents (aged 65+ years) within the care home setting. This includes agency staff with at least 6-months experience working in care homes.
• Staff working in the residential care home sector (e.g. care home managers) and in regular contact with care home residents (e.g. nursing staff) will also be eligible to participate.
• Care homes will be providing 24/7 in-person support, and this is inclusive of residential care home, nursing care homes, specialist dementia care or nursing home, dual-registered care homes and extra care housing (assisted living or very sheltered housing).
• All geographical regions in England inclusive of multi-ethnic, urban, and rural populations.
• Aged over 18 years of age.

Task 2 Qualitative interviews

• Care home staff (including carers, care home managers and nursing staff) currently working in the care home environment and with at least 6-months' experience of working in this environment, with experience of providing personal care. This includes agency staff.
• Care home residents with experience of foot care needs.
• Family/friends of residents who are involved in their care planning/provision.
• Family caregivers will include spousal, sibling, and parent/child relations.
• All participants must have capacity to give informed consent.
• All participants must be able to take part in an interview in English.
• Aged over 18 years of age.
• Where a virtual interview is requested, access to the appropriate technology.

Exclusion Criteria:

Task 1 National Survey

• Residents living within care home and/or their family members.
• Care staff working in non-care home sector(s) e.g. domiciliary care.
• Staff in non- care roles (e.g. catering or maintenance)

Task 2 Qualitative interviews

• Care staff working in non-care home sector(s) e.g. domiciliary care.
• Staff in non- care roles (e.g. catering or maintenance)
• Those determined not to have mental capacity to consent to participation, in line with the Mental Capacity Act.
• Care home residents with communication impairments which would preclude participation in the interview even with reasonable adjustments.
• Unable to take part in an interview in English language.

England