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A review of why patients with leg ulcers do not adhere to treatment

Ann Van Hecke UGent, Maria Grypdonck UGent and Tom Defloor UGent (2009) Journal of Clinical Nursing. 18(3). p.337-349
abstract
To provide an overview of what is known thus far about reasons for and determinants of non-adherent behaviour. Compression, leg exercises and leg elevation are regarded as essential components in leg ulcer treatment and in the prevention of ulcer recurrence. Non-adherence to leg ulcer regimen is a major problem. Reasons for non-adherence are not fully understood. Systematic review. Medline, CINAHL and the Cochrane database were explored from 1995 - December 2007. Reference lists of retrieved articles were searched. Studies were eligible if they included patients with venous or mixed leg ulcers, reported reasons or determinants of non-adherence and were published in English, Dutch, French or German. Thirty-one studies were included. Non-adherence is a multidimensional problem. Pain, discomfort and lack of valid lifestyle advice by healthcare professionals were primary reasons for non-adherence from patient's perspective. Healthcare professionals mainly focus on patient-related factors such as poor motivation, lack of knowledge and understanding and unwillingness. The beliefs that compression was unnecessary, uncomfortable, worthwhile and prevented recurrence significantly determined (non-)adherence. Interventions to promote adherence will require a multifaceted approach and a holistic comprehensive assessment. Therapeutic non-judgemental relationships are essential to enhance patient adherence. Effective pain management is recommended and social support by family or significant others could be encouraged. Healthcare professionals should give clear, unambiguous and tailored information. Research can best focus on the factors and processes affecting patient adherence to leg ulcer treatment. Comprehensive adherence-enhancing strategies could be developed and their effectiveness should be tested.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (review)
publication status
published
subject
keyword
nursing, leg ulcers, Adherence
journal title
Journal of Clinical Nursing
J. Clin. Nurs
volume
18
issue
3
pages
337 - 349
Web of Science type
Review
Web of Science id
000262476100003
JCR category
NURSING
JCR impact factor
1.194 (2009)
JCR rank
16/70 (2009)
JCR quartile
1 (2009)
ISSN
0962-1067
DOI
10.1111/j.1365-2702.2008.02575.x
language
English
UGent publication?
yes
classification
A1
id
504584
handle
http://hdl.handle.net/1854/LU-504584
date created
2009-02-23 09:41:14
date last changed
2015-06-17 11:08:06
@article{504584,
  abstract     = {To provide an overview of what is known thus far about reasons for and determinants of non-adherent behaviour.
Compression, leg exercises and leg elevation are regarded as essential components in leg ulcer treatment and in the prevention of ulcer recurrence. Non-adherence to leg ulcer regimen is a major problem. Reasons for non-adherence are not fully understood.
Systematic review.
Medline, CINAHL and the Cochrane database were explored from 1995 - December 2007. Reference lists of retrieved articles were searched. Studies were eligible if they included patients with venous or mixed leg ulcers, reported reasons or determinants of non-adherence and were published in English, Dutch, French or German. Thirty-one studies were included.
Non-adherence is a multidimensional problem. Pain, discomfort and lack of valid lifestyle advice by healthcare professionals were primary reasons for non-adherence from patient's perspective.
Healthcare professionals mainly focus on patient-related factors such as poor motivation, lack of knowledge and understanding and unwillingness. The beliefs that compression was unnecessary, uncomfortable, worthwhile and prevented recurrence significantly determined (non-)adherence.
Interventions to promote adherence will require a multifaceted approach and a holistic comprehensive assessment. Therapeutic non-judgemental relationships are essential to enhance patient adherence. Effective pain management is recommended and social support by family or significant others could be encouraged. Healthcare professionals should give clear, unambiguous and tailored information. Research can best focus on the factors and processes affecting patient adherence to leg ulcer treatment. Comprehensive adherence-enhancing strategies could be developed and their effectiveness should be tested.},
  author       = {Van Hecke, Ann and Grypdonck, Maria and Defloor, Tom},
  issn         = {0962-1067},
  journal      = {Journal of Clinical Nursing},
  keyword      = {nursing,leg ulcers,Adherence},
  language     = {eng},
  number       = {3},
  pages        = {337--349},
  title        = {A review of why patients with leg ulcers do not adhere to treatment},
  url          = {http://dx.doi.org/10.1111/j.1365-2702.2008.02575.x},
  volume       = {18},
  year         = {2009},
}

Chicago
Van Hecke, Ann, Maria Grypdonck, and Tom Defloor. 2009. “A Review of Why Patients with Leg Ulcers Do Not Adhere to Treatment.” Journal of Clinical Nursing 18 (3): 337–349.
APA
Van Hecke, A., Grypdonck, M., & Defloor, T. (2009). A review of why patients with leg ulcers do not adhere to treatment. Journal of Clinical Nursing, 18(3), 337–349.
Vancouver
1.
Van Hecke A, Grypdonck M, Defloor T. A review of why patients with leg ulcers do not adhere to treatment. Journal of Clinical Nursing. 2009;18(3):337–49.
MLA
Van Hecke, Ann, Maria Grypdonck, and Tom Defloor. “A Review of Why Patients with Leg Ulcers Do Not Adhere to Treatment.” Journal of Clinical Nursing 18.3 (2009): 337–349. Print.