“Sometimes I just want to … give up.” Compounding and Intersectional barriers to foot & health care among individuals experiencing homelessness

Individuals experiencing homelessness face a disproportionate burden of foot-related health conditions, compounded by challenges in navigating systems of care and advocating for their needs. While the barriers associated with accessing healthcare among unhoused individuals have been established, few studies have explored the intersection of systemic disadvantage with foot health. This qualitative study comprised of twelve interviews conducted with individuals experiencing homelessness. A trauma-informed, community-based participatory approach was used. Interviews were conducted in private locations outside and within a community shelter. They were transcribed and analyzed using a line-by-line Grounded Theory approach. Through engagement with the data, authors constructed an understanding of numerous barriers: from self conception to interpersonal interactions to the systemic/structural forces that governed experience. Burdens were compounded by their intersectional nature, with the experience of the structural and systemic exacerbating physical foot and mental health conditions that made it further difficult to access care. This work articulates novel, under-considered relationships: how the physical state of one’s feet intersects with self concept and mental health. By centering the lived experiences of unhoused persons, there exists the potential to redistribute agency to allow patient stories to inform provider praxis.