Self-treatment of wounds: a mixed methods study

Abstract

A chronic wound is a disruption of the structure and function of the skin associated with protracted healing. Chronic wounds affect 2% of Australians and cost US$2.85 billion per annum. Chronic wounds have a negative effect on the physical, emotional, social, lifestyle and financial domains of quality of life.

Wound treatment involves wound assessment, wound cleansing, debridement of devitalised tissue and the application of wound dressings. Individuals often seek professional services for wound treatment, however the researchers experience and some published evidence suggests that patients sometimes self-treat. Successful self-treatment of chronic wounds has the potential to improve wound healing and the individual’s well-being. A self-care approach to wound treatment may also help to relieve pressure on healthcare services and reduce the economic burden of this condition.

The aim of this research was to investigate self-treatment of chronic wounds among people living in the community to inform the development of educational resources and supports for this group. The objectives of this research were to describe the characteristics of people who self-treat, to determine their self-treatment practices and to explore the effect of self-treatment on quality of life.

A sequential explanatory design mixed methods study was conducted in Australia and Wales. Data collection involved participants completing one survey (n=113), and a sub-group of the sample completed one in-depth interview (n=25), and one observation of their self-treatment (n=8).

The sample was 63.6 years of age on average, self-treated wounds that were 109 weeks duration on average and more than three quarters (n=89, 78.8%) had a leg wound. Health-related quality of life was sub-optimal, 6/10 (ave.) according to the Cardiff Wound Impact Schedule. The majority of self-treaters reported conducting wound cleansing (n=103, 91.2%), wound dressing removal (n=101, 89.4%), wound dressing application (n=100, 88.5%), and wound assessment (n=94, 83.2%). Wound imaging (n=38, 33.6%) and wound debridement (n=46, 40.7%) were conducted by less than half of the sample.

The most common reasons for self-treating were to be independent (n=66, 58.4%) and to do the treatment at a time that suited (n=62, 56.6%). Few self-treaters reported receiving structured education to assist them to self-treat (n=6, 5.3%). Self-treaters had spent on average AU$2475 on wound dressing products since the wound started, and AU$121.82 in the most recent 4 weeks which represented 12% of their disposable income.

Observations of self-treatment identified that participants conducted the above mentioned self-treatment activities however often not in the most effective manner. The interviews conducted in this study suggested that the effect of self-treatment on quality of life was mainly positive, in particular it improved pain, reduced worry about infection, had financial benefits, and allowed the individual to recapture time lost when receiving professional care.

This research has demonstrated the need to develop educational resources and supports for people who self-treat chronic wounds. These resources should include a tool to appraise self-treatment capacity and an e-learning education program to teach patients and their significant other how to self-treat. These resources also have the potential to guide and standardise the practices of healthcare professionals who educate and support self-treaters, and encourage a shared care approach to this self-treatment practice.