Healthcare delivery Fig 1
the individual’s preferences, beliefs and circumstances.5-7
Earlier compliance-based
models positioned the clinician as the prescriber of treatment and the patient as its recipient. Contemporary guidance instead emphasises shared decision making, patient activation and supported self-management as essential components of personalised care.6,8 Research exploring patient activation demonstrates that individuals vary significantly in their knowledge, confidence and ability to manage their health.9
Importantly, activation
is not fixed; it develops over time through education, encouragement and supportive clinical relationships. A patient who initially feels unable to participate in self-management may, with appropriate guidance, gradually gain the skills and confidence required to do so. Within lower limb care, where treatment often
involves complex routines such as compression application, skin care and symptom monitoring, these differences in confidence and capability become particularly significant. Studies examining chronic wound management highlight that patient engagement is strongly influenced by factors including understanding of the condition, perceived benefits of treatment and the level of support provided by healthcare professionals.7 When viewed through this broader perspective, the label “non-compliant” becomes less informative, functioning as a conclusion rather than an explanation of behaviour. Qualitative research involving people with venous leg ulcers indicate that engagement with compression therapy is shaped by interacting factors, including discomfort, treatment burden, individual routines, previous experiences and the organisation of services, not simply by knowledge or motivation.10
Reframing reluctance
as clinically relevant information rather than a judgement enables clinicians to explore what may be making treatment difficult, what matters to the individual and what support or adaptation might make participation more achievable. This reflects Rogers’ person-centred theory that ‘meaningful change’ is more likely when individuals feel understood and accepted than when they experience correction or instruction.11 Although developed within psychotherapy, this principle remains relevant to contemporary healthcare and is reflected in patient engagement and shared decision making guidance, which emphasises understanding an individual’s preferences, circumstances and priorities before jointly agreeing a realistic plan of care.6,7
The more constructive question
is therefore not “Why is this patient failing to comply?”, but “What is preventing this treatment from working for this person, and how can we address it together?”
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Fig 1.
Reluctance is rarely irrational When patients do not follow a recommended treatment plan, their behaviour may be attributed to poor adherence, limited motivation or insufficient understanding of their condition. However, hesitation about participating in lower limb self-care often becomes understandable when considered in the context of the patient’s concerns, experiences and practical circumstances: Fear: Many individuals living with chronic lower limb conditions have experienced repeated ulcer recurrence, infection or hospitalisation. For these patients, regular visits from healthcare professionals represent safety and reassurance. The suggestion that they begin undertaking aspects of care themselves can therefore feel
like stepping away from that safety net. Pain and discomfort: Compression therapy continues to be the mainstay of venous leg ulcer treatment, as it addresses the venous hypertension responsible for ulcer formation and delayed healing.12
However, patients may
initially find compression therapy restrictive, hot or uncomfortable. Bandaging may interfere with sleep, mobility or daily routines, while compression hosiery can be physically challenging to apply. For patients already managing chronic pain or reduced mobility, these practical difficulties may outweigh the perceived benefits of treatment. Confidence: Tasks that feel routine to experienced clinicians, such as applying compression evenly or recognising early signs of skin deterioration, may feel complex and intimidating to individuals without clinical support. Without structured education and repeated reassurance, patients may worry about doing something incorrectly and causing harm.
Health literacy: Health literacy encompasses
not only the ability to read health information but also the capacity to understand, interpret and apply that information accurately.8
When
explanations rely heavily on clinical terminology or written materials alone, patients may appear to agree with advice, while privately feeling uncertain about how to implement it. Practical and social factors: Applying
compression independently requires physical capability, suitable living conditions and sometimes assistance from family members or carers. Individuals living alone, experiencing reduced dexterity or managing multiple long term conditions may find these expectations difficult to meet. Previous healthcare experiences: Painful
procedures, slow recovery, infections, or negative interactions may make patients cautious about treatment changes. Frequent nurse visits can provide reassurance, so managing care independently might feel uncomfortable. Where trust has been challenged or confidence reduced, patients may
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