Table 2.

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

Authors/Country	Sample/Data collection/Data analysis	Aetiology/Ulcer duration	Problems experienced by leg ulcer patients with respect to:
			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