Healthcare delivery
Engaging reluctant patients in lower limb self-care
Successful implementation of lower limb self-care depends not only on clinical governance and professional confidence, but also on patient engagement. In this article, Andrew Kerr, Lisa Wood and Lesley McDonagh discuss the support and understanding required to overcome barriers to engage ‘reluctant’ patients in self-care.
Across healthcare, the movement towards supported self-care is gaining momentum. Rising demand, workforce pressures and the increasing prevalence of long-term conditions have encouraged services to reconsider how care is delivered, with greater emphasis placed on the partnership between clinicians and patients. In lower limb management, where venous leg ulcers and chronic oedema often require prolonged treatment and regular monitoring, self-care models offer an opportunity to improve sustainability while supporting patient independence.1 Previous articles in this series have explored
both the organisational case for lower limb self-care and the professional transition required from clinicians, as services move away from exclusively nurse-led models.2,3
However,
successful implementation depends not only on clinical governance and professional confidence, but also on patient engagement. Even when services provide structured pathways, education and appropriate safeguards, some patients may feel hesitant or reluctant to take on elements of their own care. Within clinical documentation, this reluctance
is often described using the familiar term “non-compliant”. While the term may be used routinely and without judgement, it can unintentionally oversimplify complex behaviours. When viewed from the perspective of the patient’s lived experience, reluctance to engage with self-care is rarely irrational. Concerns about pain, fear of deterioration, lack of confidence, practical limitations and previous healthcare experiences can all shape how individuals respond when asked to participate more actively in their treatment. Understanding these factors is essential for
clinicians seeking to support effective shared care. Rather than viewing resistance as a barrier, it may be more helpful to interpret it as an opportunity for exploration and dialogue. By recognising the underlying drivers of hesitation and adapting communication accordingly,
clinicians can help patients build the confidence and capability needed to participate safely in their care. Supporting patients who feel hesitant about participating in self-care is therefore not about persuading them to accept responsibility they do not want. Instead, it involves understanding the realities they face and creating the conditions in which confidence and participation can develop gradually and sustainably.
The myth of the ‘non-compliant patient’ The term “non-compliant” remains familiar within clinical vocabulary and continues to be used in medical records to describe patients whose behaviour does not correspond with prescribed recommendations.4
In lower limb
care, it is often associated with compression therapy or lifestyle advice and may appear in phrases such as “non-compliant with hosiery”, “removes bandages” or “does not elevate legs”. Such terminology can provide convenient shorthand in busy clinical environments, particularly when healing has stalled or ulceration has recurred. However, while it may appear neutral, it can oversimplify complex patient behaviour and obscure the factors
influencing engagement with care. Terminology relating to patient engagement has evolved alongside changing models of care, reflecting a gradual movement from clinician directed treatment towards greater patient choice, shared decision making and a collaborative partnership.
Although the terms compliance, adherence and concordance are sometimes used interchangeably, they represent distinct understandings of the relationship between patients, clinicians and treatment decisions (Table 1).
Compliance refers to the extent to which a patient follows the recommendations of a healthcare professional, reflecting a traditional model in which treatment decisions are largely clinician led. Adherence describes the extent to which a person’s behaviour corresponds with recommendations agreed with a healthcare professional, recognising the individual’s role in deciding whether and how treatment is followed. Concordance extends this further by
describing a negotiated partnership in which clinicians and patients make treatment decisions together, taking account of
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