Developing a Suite of Resources to Improve Patient Adherence to Compression Stockings: Application of Behavior Change Theory

Research output: Contribution to journalArticleResearchpeer-review


Purpose: Poor patient adherence to compression stockings remains a difficult and pervasive problem for clinicians, with costly
repercussions for patients and health-care systems. The purpose of this paper was to describe the application of behavior change
theory to the systematic development of a suite of resources, aimed at improving patient adherence to wearing compression
Methods: Employing a non-empirical approach, behavior-change theory was used to develop an innovative intervention as part of a
multi-phase project. Target behaviors, barriers and potential enablers were identified in relation to stocking adherence. An impactlikelihood matrix for behavior prioritization was used to identify possible areas for intervention within occupational therapy outpatient
clinics. Selection of suitable resources and their consequent development were based on a narrative and problem-solving process by a
panel of clinical experts.
Results: Of 14 potential domains embedded in the Theoretical Domains Framework, the key target behaviors and barriers were
associated with eight domains. Michie’s Behavior Change Wheel revealed recommendations in six subdivisions and of these, four
intervention functions were selected by the panel, based on their potential impact and likelihood of adoption in clinical practice.
Findings led to the development of a suite of resources comprising a new questionnaire, a clinical decision tree, augmented by clinical
answer sheets corresponding to each of the barriers.
Conclusion: Application of behavior change theory informed the design of a behavior change intervention comprising an integrated
suite of resources for novice and experienced clinicians.
Practice Implications: These novel resources have potential to improve patient adherence to compression stockings and consequently generate health-care savings through reduced need for wound care products, and medical interventions with translation to other
settings and conditions requiring compression stockings. Patient outcomes will likely be improved with reduced pain, improved quality
of life and earlier resumption of usual occupations.
Keywords: compression stockings, adherence, behavior change theory, Behavior Change Wheel, COM-B model, Theoretical
Domains Framework, venous leg ulcers
Original languageEnglish
Pages (from-to)51-66
Number of pages16
JournalPatient Preference and Adherence
Publication statusPublished - 6 Jan 2023


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