An exploration of barriers to and enablers of offering treatments to prevent recurrence of venous leg ulcers

Abstract

Aim

To: (1) explore the factors influencing the offering of venous leg ulcer (VLU) recurrence preventative treatments from the perspective of NHS nurses, and (2) recommend potential intervention strategies to ameliorate inhibitors to offering those preventative treatments.

Methods

This qualitative study used semi-structured online interviews with seventeen NHS nurses who provide wound care. The interviews were guided by the Capabilities, Opportunities and Motivation model of Behaviour change (COM-B). Framework Analysis, incorporating inductive coding to capture emergent themes and deductive coding informed by the Theoretical Domains Framework (TDF) was conducted. NVivo software aided data management, and coding was conducted collaboratively by an interdisciplinary team.

Results

Data were mapped to six relevant TDF domains. Three of these domains were found to influence offering of both preventative treatments. While nurses understood the importance of VLU care post-healing, there was a perception of limited provision of prophylactic treatments in NHS organisations (environmental context and resources), which can be reflected in the lack of embedding national guidelines into local pathways (memory, attention and decision processes). Nevertheless, some nurses acknowledged the significance of their role in offering those prophylaxis with their patients (social/professional role and identity).

In addition to the primary three domains, two more domains were identified influencing offering of prophylactic compression. While some nurses lacked confidence in offering the strongest tolerated compression (beliefs about capability), working within an experienced team was perceived to enhance their confidence and support optimal prescription of prophylactic compression. Furthermore, with the primary three domains, one additional domain was identified influencing referrals to vascular services. Nurses interviewed were largely unaware of endo-venous ablation surgery as a prophylactic treatment option for people with healed VLUs (knowledge). Five intervention functions (environmental restructuring, enablement, education, modelling and persuasion), and nine behaviours change technique groupings (goals and planning, antecedents, associations, self-belief, comparison of behaviour, repetition and substitution, comparison of outcomes, social support and shaping knowledge) were identified.

Conclusions

The identified intervention functions and the behaviour change techniques can inform the design of future intervention. Key targets for change include service-focused elements on VLU care after healing and the integration of national guidelines with local resources to aid decision-making and boost opportunities to offer evidence-based approaches to reduce or prevent recurrence of VLUs.