The impact of psychosocial factors on adherence to compression therapy to prevent recurrence of venous leg ulcers

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Abstract
To identify self-care activities undertaken and to determine relationships between self-efficacy, depression, quality of life, social support and adherence to compression therapy in a sample of patients with chronic venous insufficiency. Up to 70% of venous leg ulcers recur after healing. Compression hosiery is a primary strategy to prevent recurrence; however, problems with adherence to this strategy are well documented and an improved understanding of how psychosocial factors influence patients with chronic venous insufficiency will help guide effective preventive strategies. Cross-sectional survey and retrospective medical record review. All patients previously diagnosed with a venous leg ulcer that healed between 12-36 months prior to the study were invited to participate. Data on health, psychosocial variables and self-care activities were obtained from a self-report survey and data on medical and previous ulcer history were obtained from medical records. Multiple linear regression modelling was used to determine the independent influences of psychosocial factors on adherence to compression therapy. In a sample of 122 participants, the most frequently identified self-care activities were application of topical skin treatments, wearing compression hosiery and covering legs to prevent trauma. Compression hosiery was worn for a median of four days/week (range 0-7). After adjustment for all variables and potential confounders in a multivariable regression model, wearing compression hosiery was found to be significantly positively associated with participants' knowledge of the cause of their condition (p = 0.002), higher self-efficacy scores (p = 0.026) and lower depression scores (p = 0.009). In this sample, depression, self-efficacy and knowledge were found to be significantly related to adherence to compression therapy. These findings support the need to screen for and treat depression in this population. In addition, strategies to improve patient knowledge and self-efficacy may positively influence adherence to compression therapy.