Developing a Suite of Resources to Improve Patient Adherence to Compression Stockings: Application of Behavior Change Theory

Abstract

Purpose Poor patient adherence to compression stockings remains a difficult and pervasive problem for clinicians, with costly repercussions for patients and health-care systems. The purpose of this paper was to describe the application of behavior change theory to the systematic development of a suite of resources, aimed at improving patient adherence to wearing compression stockings. Methods Employing a non-empirical approach, behavior-change theory was used to develop an innovative intervention as part of a multi-phase project. Target behaviors, barriers and potential enablers were identified in relation to stocking adherence. An impact-likelihood matrix for behavior prioritization was used to identify possible areas for intervention within occupational therapy outpatient clinics. Selection of suitable resources and their consequent development were based on a narrative and problem-solving process by a panel of clinical experts. Results Of 14 potential domains embedded in the Theoretical Domains Framework, the key target behaviors and barriers were associated with eight domains. Michie’s Behavior Change Wheel revealed recommendations in six subdivisions and of these, four intervention functions were selected by the panel, based on their potential impact and likelihood of adoption in clinical practice. Findings led to the development of a suite of resources comprising a new questionnaire, a clinical decision tree, augmented by clinical answer sheets corresponding to each of the barriers. Conclusion Application of behavior change theory informed the design of a behavior change intervention comprising an integrated suite of resources for novice and experienced clinicians. Practice Implications These novel resources have potential to improve patient adherence to compression stockings and consequently generate health-care savings through reduced need for wound care products, and medical interventions with translation to other settings and conditions requiring compression stockings. Patient outcomes will likely be improved with reduced pain, improved quality of life and earlier resumption of usual occupations.

Leg Lymphoedema After Inguinal and Ilio-Inguinal Lymphadenectomy for Melanoma: Results from a Prospective, Randomised Trial

“… 30 It is likely that patient perception of threat and their coping strategies, including their perception of lymphoedema being a problem, their ability to don garments, garment cost, comfort, and employment contributes to their adherence to compression. 31 – 33 …”

Various Therapies for Lymphedema and Chronic Venous Insufficiency, Including a Multimodal At-Home Nonpneumatic Compression Treatment

“…16 Ostby and Armer 17 and Bar et al 18 demonstrated poor adherence over a 20-year investigative period in relation to lower extremity lymphedema/venous disorders. 17,18 Adherence issues arise when patients need to wear a snug or tight garment to help contain edema for lifelong management. A person's dexterity and mobility can further contribute to poor adherence.…”

“…However, the donning and doffing of these garments remain a challenge, which can lead to poor adherence 16 . Ostby and Armer 17 and Bar et al 18 demonstrated poor adherence over a 20-year investigative period in relation to lower extremity lymphedema/venous disorders 17,18 . Adherence issues arise when patients need to wear a snug or tight garment to help contain edema for lifelong management.…”