research Contribution of the Leg Club model of care to the well-being of people living with chronic wounds l Objective: Social support impacts well-being. Higher levels of social support encourage treatment adherence and aid healing in people living with chronic wounds. The Leg Club model of care harnesses social support mechanisms to improve patient outcomes. This study investigated whether social support mechanisms available through a Leg Club environment influenced well-being. l Method: Participants were community Leg Club members. Socio-demographic data was collected, and the Well-being in Wounds Inventory (WOWI) administered to assess ‘wound worries,’ ‘personal resources,’ and ‘well-being’. Participants’ perceived social situation, length of time attending a Leg Club, wound duration, and feelings about their physical appearance were also measured. l Results: The subjects recruited (n=49) were aged between 50 and 94 years (mean=75.34, standard deviation=10.31). Membership of a Leg Club did impact well-being factors. Time spent at a Leg Club improved ‘personal resources’ over time. ‘Perceived social situation’ predicted key aspects of well-being, as did ‘time spent attending a Leg Club’ and ‘feelings about physical appearance.’ Social support and relief from social isolation were important aspects of Leg Club membership for participants. l Conclusion: Attending a Leg Club enhances well-being in people living with a chronic wound; social support has an important role to play in this relationship. Future research should consider the specific interplay of social support mechanisms of Leg Club, and other relevant wound-related variables to optimise patient well-being and treatment outcomes. l Declaration of interest: The Urgo Foundation funded this project. The authors have no conflicts of interest to declare. social support; well-being; wounds; Leg Club; WOWI t is well-established that people living with from significant others, such as family members, D. Upton, PhD, FBPsS, chronic ulceration experience unique physical friends or co-workers’.13 Social support may also Associate Dean, Education; 1,2 and psychosocial disadvantages. Recurring come from professional sources, such as health pro- P. Upton, CPsychol, pain, associated poor mobility and sleep depri- fessionals.10 Both the number of support sources AFBPsS, Senior Research vation, as well as malodour and exudate at the and the perceived availability and quality of support Fellow; Iwound site, have all been reported as having a detri- are important.14 Poor social support has been associ- R. Alexander, BScPsy 3–5 15–17 (Hons), mental impact on health and well-being. Social iso- ated with increased morbidity and mortality. Research Assistant; lation, negative emotion, depression and anxiety Previous research has indicated that people with All at the have also been described as impacting adversely on low levels of social support have higher mortality University of Canberra, patients with chronic wounds.6,7 In recent years, rates from cardiovascular disease;18–20 cancer;21 and ACT, 2601 there has been a call for research into the well-being infectious diseases, such as HIV-AIDS.22 Low levels Email: dominic.upton@ 8 of people with chronic wounds. Well-being encom- of social support have also been linked to delayed canberra.edu.au passes positive emotions, life satisfaction, coping recovery from health conditions such as: cardiovas- skills, optimism and hope for the future, and it could cular disease, atherosclerosis, cancer recovery and be considered these positive resources are manifest to general wound healing.20,23,24 Within chronic wound protect the individual from the negative consequenc- care literature, patients with low levels of social sup- 6 l t d es of the wound. Patient well-being has the potential port had higher wound recurrence and delayed r e 9,25,26 A to impact treatment adherence, wound healing and healing rates. c H 7,9 l t improve patient outcomes. One significant mechanism at play is the relation- A e An important contributor to well-being is social ship between low social support and increased phys- support, which has been linked to both mental and iological27,28 and psychological stress.11 People living physical health.10–12 Social support has been defined with chronic wounds experience increased social s © 2015 MA H as ‘emotional, informational or practical assistance isolation as a result of mobility issues and negative J O U R N A L OF WOUND CARE VOL 24, NO 9, SEPTEMBER 2015 3 9 7 research emotion, such as shame and embarrassment about es in well-being over time to be assessed. The conven- malodour and exudate.3,6 Consequently, they social- ience sample for this study was drawn from commu- ise less, have fewer social contacts, lack social sup- nity Leg Clubs across seven localities in the UK. port, and are more vulnerable to stress.10 There is strong evidence of a relationship between stress and Well-being in Wounds Inventory delayed wound healing.7,29–33 A vicious cycle is gen- The Well-being in Wounds Inventory (WOWI) erated as high stress and social isolation combine to measures aspects of well-being in people living with delay wound healing, leading to greater stress and chronic wounds. Brief statements are measured on isolation and poorer social support.7 five-point bipolar scales (1=strongly agree to Conversely, there is evidence that supportive social 5=strongly disagree) and indicate the degree to relationships can improve health and psychological which each statement reflects an individual’s per- well-being.16 Animal studies have shown that rates of sonal experience. The WOWI taps issues affecting wound healing are improved in socially facilitated patient well-being (for example, concerns about animals compared with socially isolated animals.34 wound pain, appearance, treatment) and negative Human studies in this field are limited; however, emotions connected with having a wound (for research into social support interventions have inves- example, anxiety, stress, depression). The question- tigated the efficacy of Leg Clubs and found some evi- naire also measures positive emotions and strength- dence that this treatment model is advantageous to based resources (for example social support, life sat- both adherence and wound healing rates.35,36 isfaction, hope for the future, coping skills). The Lindsay Leg Club is one model of wound care The WOWI results in an overall ‘well-being’ (WB) that harnesses social support mechanisms improv- score, which encompasses scores from two subscales: ing patient outcomes. This treatment model pro- ‘wound worries’ (WW) describes concerns and nega- vides holistic care and health information to people tive emotions associated with having a chronic living with a chronic wound in a supportive, infor- wound, and ‘personal resources’ (PR) encapsulates mal environment.37,38 The Leg Club is held at a com- social support, capacity for positive emotions, per- munity venue, such as a church or village hall, and sonal qualities like optimism, resilience, hope, and is open access, with no appointment necessary. coping skills. The WOWI has been assessed as a high- Members drop-in and are treated collectively by ly feasible instrument, with good test–retest reliability health professionals, while having the opportunity (WW ICC(1,1)=0.79; PR ICC(1,1)=0.83; WB to share their experiences and learn more about ICC(1,1)=0.84). Additionally, the WW subscale was 39 how best to manage their wound. The Lindsay Leg highly responsive to change over time (R2=0.78), and Club philosophy is based on increasing peer and the overall WB scale moderately responsive 39 social support in order to maximise treatment (R2=0.31). adherence and improve healing. Early research sug- gests that patients treated in such a ‘Leg Club’ envi- Interview schedule ronment show significantly improved wound heal- During a brief interview, participants’ were asked ing, quality of life, morale, self-esteem, pain, and about their perceptions of their social situation, the functional ability compared to patients treated at duration of time they had their wound, the amount home by community nurses.35,36 However, evidence of time spent attending a Leg Club, and their feel- is scant and the contribution of ‘Leg Club’ attend- ings about the physical appearance of their wound. ance to an individual’s well-being has yet to be Participants responded to these questions using a established. A study was therefore undertaken to Likert-type scale (1=serious issues/concerns to evaluate the impact of Leg Club attendance on indi- 5=no problems/concerns). Finally, participants were vidual well-being. Specifically the study aimed to: asked to reflect freely on what the Leg Club experi- l Assess the impact of Leg Club attendance on indi- ence meant to them. vidual well-being over time l Identify the contribution of Leg Club attendance Procedure and other physical and psychosocial wound-related Community Leg Clubs were approached to facilitate factors to well-being introductions with members of selected groups. The l Explore individual perceptions of how Leg Club researchers met with each community group and pro- impacts on the experience of living with a wound. vided Leg Club members with information outlining the purpose and content of the study. Written con- l t d r e Method sent was provided by those agreeing to participate. A c H Design and sample On the initial visit, participants completed a series of l t A The study was conducted as a multi-method survey, demographic questions, all sections of the WOWI e with a fixed-response questionnaire, plus closed and and a short interview about their Leg Club experi- open-ended interview questions. The questionnaire ences. Researchers returned to Leg Clubs at least six was administered at two time points to enable chang- weeks later to readminister the WOWI. © 2015 MA H 3 9 8 J O U R N A L OF WOUND CARE VOL 24, NO 9, SEPTEMBER 2015 research tion was detected for the other subscale ‘Wound wor- Table 1.