EFFECT OF A STRUCTURED PATIENT EDUCATION PROGRAM ON SELF-CARE AND COMPRESSION THERAPY ADHERENCE IN VENOUS LEG ULCER PATIENTS: A PROSPECTIVE REPEATED-MEASURES STUDY

Abstract

Aim: To examine attitudes of patients with chronic venous leg ulcers toward compression therapy and self-care, and to assess the effect of a structured educational intervention on changes in attitudes and behaviours, particularly adherence to compression therapy.

Participants and Methods: A prospective repeated-measures study was conducted at three time points in the Phlebology Outpatient Clinic of the Department of Dermatology and Venereology at the University Hospital Centre Split, from July 2024 to April 2025. Nineteen adult patients with chronic venous leg ulcers were included. Two structured questionnaires were used to assess wound self-care behaviours and attitudes toward compression therapy, and the Dermatology Life Quality Index was administered. The wound area was measured using a transparent film with a millimetre grid. The educational intervention was delivered individually by a nurse, using verbal instruction and demonstration of wound care and the correct application of compression therapy. Data were analysed using the Friedman test, McNemar test, and post hoc Wilcoxon signed-rank test with Bonferroni correction (p<0.05).

Results: The sample included 11 men (58%) and 8 women (42%), with a median age of 67 years (43-87). Independent wound dressing increased from 21% to 74% at 90 days (p=0.002). Wound irrigation increased from 42% to 100% at 90 days, with a shift toward using tap water (p<0.001). Dressing changes “as needed” increased from 16% to 74% (p=0.001), and regular skin care from 10% to 84% (p<0.001). Use of compression therapy increased from 32% before education to 100% at 90 days (p<0.001), and the proportion of participants who believed compression should be continued after wound healing increased from 31.6% to 100% at 90 days (p<0.001). Median pain decreased from 7 to 0 at 90 days (p<0.001), and median wound area from 15 cm² to 0 cm²
(p<0.001). Wound healing was observed in 63% of participants at 90 days.

Conclusion: Structured, individualised nurse-led education was associated with improved attitudes and behaviours related to wound self-care and a marked increase in adherence to compression therapy. Along with behavioural changes, clinically relevant improvements in pain, wound area, and quality of life were observed. These findings support incorporating structured education into standard care for patients with chronic venous leg ulcers. The larger studies with longer follow-up are needed to assess longterm
sustainability and prevention of recurrence.