Adherence to leg ulcer lifestyle advice: qualitative and quantitative outcomes associated with a nurse-led intervention

Aim and objectives: Examining the (experienced) changes associated with a nursing intervention to enhance adherence to leg ulcer lifestyle advice.

Background: Few interventions to enhance adherence to leg ulcer treatment are developed and tested.

Design: Qualitative evaluation approach and pre-post-test design were used.

Method: Twenty-six patients with venous ulcers in a community care setting participated. Data were collected by means of interviews and participant observation. Frequency and duration of wearing compression, leg exercising and leg elevation, activity level, pain and ulcer size were registered at baseline, after the end of the intervention and three months later. Inductive content analysis and Wilcoxon signed-rank test were used.

Results: Knowledge about leg ulcer advice increased. The education contributed to more consciously following of the advice. The rationale of the advice and its association with healing or recurrence remained often unclear. More patients performed exercises after the intervention and at follow-up. Patients often looked out onto a 'new' perspective where enhancement of quality of life and even healing might be attainable. Some patients regained independence after learning how to apply and remove compression garments themselves. The frequency of exercising and the duration of exercises increased significantly. Step counts had not altered significantly. Patients not elevating the legs at baseline elevated the legs more and for a longer period of time after the intervention. This effect on leg elevation decreased after three months. No significant changes were reported on hours wearing compression.

Conclusions: The perceived changes suggest that the intervention holds a promise for current home care. Combining qualitative and quantitative research assisted to determine the possible effects of the intervention, increasing the potential for a meaningful randomised trial in the future.

Relevance to clinical practice: Education about leg ulcer advice should be incorporated in nursing practice. Further testing of the intervention is recommended.