Personal footcare guidance: equality impact assessment

Protected Characteristics

Age

Age is a significant factor in this Equality Impact Assessment (EQIA) due to Scotland’s changing demographics. Currently, there are over one million people aged 65 and older, compared to fewer than 750,000 under the age of 15. By 2040, the number of residents aged 65 and over is expected to rise to approximately 1.4 million, accounting for around 25% of the population (Scotland's Census 2022 - Rounded population estimates).

As we age, natural changes to the skin and joints can increase the likelihood of developing foot health problems. Maintaining good foot health, including personal foot care, becomes increasingly important with age, as it can help reduce pain, improve confidence, well-being, and quality of life, as well as support health, mobility, and independence. As such, the refresh of this guidance will have a positive impact on the older population because more people will have access to the most up to date advice on how to care for their feet, supporting the positive impacts that has on wider lifestyle.

Whilst good foot health is important for older people, it is also critical to the health and wellbeing of children and young people. Evidence suggests that issues arising in early years can lead to problems like poor posture, discomfort, and difficulty walking, running, or participating in physical activities (Children's Foot Health). As such it is important that parents and carers of children and young people are aware of this guidance as it will support them in the most appropriate way. As a result, the refresh of this guidance will have a positive impact on the younger age group.

Overall, the updated guidance is expected to have a positive impact on the population at all ages as it provides relevant information, resources and signposting to services for all ages.

Disability

According to the 2022 census, the percentage of people reporting a long-term illness, disease, or condition increased from 18.7% in 2011 to 21.4% in 2022 (Scotland’s Census 2022 - Health, disability and unpaid care). Disability is highly diverse, and many health conditions can lead to foot health issues.

Personal foot care plays a vital role in overall health, social participation, mobility, and independence. For individuals with intellectual disabilities, the risk of foot health problems can be higher (Foot Health and Mobility in People With Intellectual Disabilities), and appropriate support and understanding from carers or family members is essential. As such the guidance will have a positive impact because it provides advice and signposting in one place for both individuals and their carers and family who may be supporting them.

Many physical conditions can affect foot health, including diabetes (Knowledge and associated factors of patients with diabetes towards foot self-care). Limb loss, an extreme complication of diabetes is, often preceded by infected foot ulceration (Rapid access to multidisciplinary diabetes foot care teams) caused by a minor foot problem (Signs of serious foot problems and foot infections). As such, information about how to care for feet in this guidance will help prevent further, more serious issues and will support people to know when to ask for help. It can also be used by professionals working with patients who have health conditions which can affect the feet, such as diabetes.

Research shows that individuals experiencing foot pain or discomfort are more likely to suffer from depression or anxiety (Anxiety and Depression Among Adult Patients With Diabetic Foot). People with conditions like dementia may also struggle to express concerns about their foot health but may also be likely to walk repeatedly around for a number of reasons (Why a person with dementia might be walking about). As such the publication of this guidance is important because it will support family and carers of people with dementia to provide foot care which will keep the individual safe when mobilising.

The revised Personal Footcare Guidance will be more inclusive and accessible. It will clarify what is covered by NHS podiatry services, ensuring individuals who cannot manage their own foot care, and their supporters, have access to the relevant information and support.

Gender

Studies have demonstrated associations between foot pain and female gender (Foot pain and foot health in an educated population of adults). Evidence indicates that women are three times more likely to seek podiatric care and are more likely to experience foot pain (The RCPod publishes a decade-long analysis of podiatric care data). As a result, women may have greater podiatry needs.

The refreshed guidance is expected to have a positive impact by ensuring patients and healthcare staff have access to the most current information, thereby improving access to care and self-management.

Maternity and Pregnancy

Pregnant women, particularly in the third trimester, often experience foot health challenges such as swelling, discomfort, reduced physical activity, and difficulty finding appropriate footwear (Foot health status in pregnant women).

Gestational diabetes (GDM), which causes high blood glucose during pregnancy, can lead to complications for both mother and child. Although GDM typically resolves after pregnancy, it increases the risk of type 2 diabetes later in life, for both the mother and the child. Up to 50% of women with GDM develop type 2 Diabetes within five years, postpartum, and diabetes is strongly associated with foot health issues (Gestational diabetes). Disability in relation to long-term condition of diabetes has also been considered earlier in this EQIA.

The updated guidance is expected to have a positive impact by providing pregnant women and those who support them, with relevant, up-to-date foot care advice and resources.

Gender Identity / Transgender People

There is currently no specific research suggesting that transgender individuals experience unique foot health issues. However, broader healthcare experiences should be considered.

Access to healthcare services by trans people can be high but their experiences can be poor (National LGBT Survey). The ability to access information, which is accurate, up to date and supports self-care without the need for in-person care, could be seen as a positive outcome.

Sexual Orientation

As with gender identity, there is no evidence to suggest that foot health is directly impacted by sexual orientation. However, LGBTQ+ individuals often face poorer health outcomes and report negative experiences in healthcare settings (NHS launches first ever review to tackle LGBT and health inequalities).

The updated Personal Footcare Guidance is expected to promote self-care and independence, helping to address some of these barriers by offering accessible, non-discriminatory information without requiring face-to-face interaction.

Race

Research shows that race and ethnicity can influence patient health outcomes, and some individuals have experienced discrimination from primary healthcare providers based on their race or ethnicity.

Type 2 diabetes is two to four times more likely in people of South Asian descent and African-Caribbean or Black African descent (Type 2 diabetes risk factors). People of Black African, South Asian, Chinese, or African-Caribbean descent, even those born in the UK, are at greater risk of developing type 2 diabetes, which often leads to foot health complications (Type 2 diabetes risk factors). For South Asian individuals, this increased risk can begin as early as age 25.

While educational interventions may offer support (Anti-racist interventions to reduce ethnic disparities in healthcare in the UK), the refreshed Personal Footcare Guidance acknowledges these disparities and aims to support more inclusive, proactive self-management of foot care.

Religion and Belief

There is some data which demonstrates that, in Scotland, religion has an effect on things such as access to healthcare, care and treatment, medicines, overall care (Scottish Patient Experience Survey of GP and Local NHS Services).

There is limited data linking religion or belief directly to foot health, but it is important to consider hygiene practices shaped by religious belief.

This work is not expected to have an adverse impact on individuals as a result of their religion or belief and will support self-care by providing relevant, accessible information for all.

Intersectionality

It is important to consider intersectionality as part of assessing the impact of this work on individuals - for example:

• The EQIA shows that South Asian individuals have increased risk of developing type 2 diabetes (which can increase likelihood of developing foot problems), but impacts can be compounded if the individual is also a female as evidence also gathered suggests there are greater associations between women and foot pain.

Each of these protected characteristics can be seen through an individual lens or in combination with one or more of another.