Table 2 Summary of qualitative studies: sample, data collection, and reported patient problems grouped according to domains (n = 13)

Physical Domain

Occupational Domain

Social Domain

Impact of Treatment

Psychological Domain

Bland (1996); New Zealand [25]

9 patients (4♀/5♂); Phenomenological approach

Chronic open leg ulcers (aetiology not specified); Current duration: 8 months – 6 years

Pain Leakage Smell Foot odour

Difficulties maintaining personal hygiene

Difficulties to dry bandages; Difficulties to incorporate recommendations into everyday life; Receiving conflicting information; Unable to comply with treatment regime; Needing larger size shoes because of bulk bandages

Bandages draw other people's attention to the leg, bandages are seen as unsightly, frustration about having to rest for weeks; Concern about job security; Feelings of guilt when unable to comply with treatment regime; Invasion of privacy through nurses, Concordance diminished on long-term basis

Brown (2005a, b) UK [29, 31]

8 patients; Semi-structured, in-depth interviews using an interview guide; Phenomenological approach

Various leg ulcers

Poor mobility

Social disconnected-ness

Bandages restricted mobility; No understanding of the disease; Symptom relief is more important than complete healing; Close relationship with nurses;

Anxiety over falling; Feelings of loneliness; Feelings of depression

Charles (1995); UK [8]

4 patients (1♀/3♂); Semi-standard interviews with open-ended questions; Phenomenological approach

Chronic venous leg ulcer; Duration: 5 – 35 years

Pain Impaired mobility

Health professionals do not: (1) listen to patients concerns, (2) explain treatment regimes, (3) establish empathy

Hopelessness; Helplessness; Loneliness; Loss of self-worth; Social isolation; Reduced self-esteem

Chase et al. (1997); USA [23]

37 patients; participant observation, field notes, pain logs; 7 patients interviewed using open-ended questions; Phenomenological approach

Pain Pruritus Smell Swelling Impaired mobility

Loss of job; Treatment-imposed limitations on activity

Life accommodation

A never-ending healing process; Open ulcer as a reminder of threat to tissue integrity; Body image changes; Limited social contact; Fear of amputation; Powerlessness; Difficulties in wearing shoes & clothes; Loss of freedom

Douglas (2001); UK [11]

8 patients (6♀/2♂); Formal, unstructured interviews; Grounded theory

Venous leg ulcer; Duration: > 1 year

Pain Leakage Smell Impaired mobility Sleeplessness

Perceived conflicting advice by professionals; Seeking alternative treatment options; No understanding of the disease Little knowledge of or control over treatment; Poor adherence to treatment; Relationship with professionals

Expectation; Acceptance; Disappointment; Low self-esteem, Altered body image; Loss of self-control; Effect on relationships

Ebbeskog & Ekman (2001); Sweden [26]

15 patients (12♀/3♂); Age range: 74–89; Personal interviews in form of a dialogue; Phenomenological-hermeneutic approach

Active venous leg ulcer (verified using ABPI > 0.8); Duration: 4 months – 2.5 years

Pain Leakage Impaired mobility Sleep disturbance Loss of energy

Difficulties maintaining personal hygiene;

Visiting friends had to wait until healing; Avoidance of visiting public bathing-places; Reduced social contacts;

Uncomfortable dressings; Difficulties in finding suitable shoes that fitted the bandaged foot

Altered body image; The wound is a constant reminder of the disease; Feelings of having no control over the body; Powerlessness; Feeling of being trapped; Feelings of depression; Difficulties imagining a life without leg ulcer; Fear of recurrence; Feeling that pain killers are bad for the body; Feeling that something bad might happen to the ulcer; Hopeful towards healing;

Hareendran et al. (2005); UK [24]

38 (26♀/12♂); 6 focus groups using an interview guide with open-ended questions; Individual patient interviews for questionnaire development

Venous leg ulcer; Duration: 4 months – 45 years

Pain Discharge Pruritus Sleeplessness

Difficulty bathing;

Limitation of daily living, holiday, and hobbies; Problems with family function

Disappointment with treatment;

Ulcer affected self-confidence and appearance; Increased dependency

Hopkins (2004) UK [28]

5 patients (1♀/4♂); Unstructured interview supplemented by a diary; Interpretative phenomenological analysis

Venous ulceration; Non-healing ulcers of > 1 years

Social exclusion; wasted days; private becomes public;

Good relationship with nurses;

Coping strategies: acceptance, comparison, thinking differently, hope

Hyde et al. (1999); Australia [16]

12 patients (12♀); In-depth semi-structured and follow-up interviews; Gender-specific collection method

Leg ulcer; Duration: > 3 years

Pain Leakage Smell Sleeplessness

Pain as an indication for infection; Concern about analgesic therapy; Embarrassment; Loss of femininity; Maintaining control over integrity of legs; Wearing non-preferred appeal; Loneliness Coping strategies: determination, stoicism, resilience, hope;

Hyland et al. (1994); UK [20]

22 patients; 6 focus groups Data analysis: no information

Different leg ulcer aetiologies

Pain Restrictions of activities

Receiving conflicting information; Cost of bandages

Feelings of regret, depression, loss of will power; Feelings of helplessness; Feeling unclean; Loss of femininity, Preoccupied by the ulcer, Uncertainty of healing; Patients engage in coping strategies

Klyscz et al. (1996); Germany [21]

55 patients; Unstructured interviews; Content analysis

Various stages of chronic venous insufficiency ; CVI I: (n = 18) CVI II: (n = 22) CVI III: (n = 25)

Pain Heavy legs Leg complaints Impaired mobility

Quitted leisure time activities;

Time consuming consultations; Compression bandaging hampered mobility,

Cosmetic problems (e.g. do not wear skirts or elegant shores); Coping strategies: cycling, swimming,, walking, cold shower, leg elevation,

Krasner (1998a, b); USA [22, 27]

14 patients (7♀/7♂); Semi-structured interviews; Hermeneutic phenomenological approach

Active venous leg ulcer & ulcer pain at initial interview; Current duration: 2 months – 7 years

Pain Swelling

Interference with the job

Patients are labelled non-compliant; Patients have difficulty in operationalising professional advice

Carrying on despite the pain; Feelings of depression

Walshe (1995); UK [9]

13 patients (12♀/1♂); Informal unstructured interviews; Phenomenological approach

Venous leg ulcer; Duration: 4 months – 10 years

Pain Leakage Smell Impaired mobility Sleep disturbance

Difficulties in maintaining personal hygiene

Housebound

Questioned efficacy of dressings; Perceived inconsistency of treatment; Little understanding of leg ulceration; Control of treatment given to professionals

Alteration in self-image; Pessimistic view of healing; 4 coping strategies: comparison, feeling healthy, altered expectation, being positive; Uncertainty & worry Difficulties in getting shoes & clothes