{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T00:00:56Z","timestamp":1793059256775,"version":"4.5.0"},"reference-count":59,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T00:00:00Z","timestamp":1649721600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Although patients with venous leg ulcers are involved in ulcer management, little is known about why and how these patients self-treat their ulcers without direct supervision by health professionals. Yet patients\u2019 knowledge of ulcer management can be important for achieving ulcer closure and\/or preventing recurrence. This study thus investigates the effects of an educational intervention on knowledge of self-care among patients with venous leg ulcers, mainly on wound dressing practice, compression therapy, physical activity and nutrition. Methods and participants: This research was conducted in three outpatient hospitals in central Croatia. An educational brochure was made and distributed to patients; patients were surveyed about caring for venous leg ulcers before the brochure was distributed and after 3 months. Results: In total, 208 patients were involved in the study: 112 in the experimental group and 96 in the control group. The educational intervention increased awareness of compression therapy, knowledge of recurrence prevention, appropriate lifestyle habits, and warning signs related to venous leg ulcers. Conclusions: Patient education on illness and self-care is necessary to achieve positive effects in self-care knowledge. In this study, patients learned how to change dressings, learned how to improve their lifestyle, and were empowered to deal with their illness.<\/jats:p>","DOI":"10.3390\/ijerph19084657","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T21:15:35Z","timestamp":1649798135000},"page":"4657","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["The Effect of an Educational Intervention on Self-Care in Patients with Venous Leg Ulcers\u2014A Randomized Controlled Trial"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3945-6182","authenticated-orcid":false,"given":"Mirna","family":"\u017dulec","sequence":"first","affiliation":[{"name":"Department of Nursing, Catholic University of Croatia, Ilica 242, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danica","family":"Rotar Pavli\u010d","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Medical Faculty, University of Ljubljana, Poljanski Nasip 58, 1000 Ljubljana, Slovenia"},{"name":"Galenia D.O.O., \u010cu\u010dkova Ulica 17, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"\u017dulec","sequence":"additional","affiliation":[{"name":"Department of Psychology, Catholic University of Croatia, Ilica 242, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,12]]},"reference":[{"key":"ref_1","unstructured":"Harding, K., Dowset, C., Fias, L., Jeines, R., Mosti, G., Olen, R., Partch, H., Reeder, S., Senet, P., and Soriano, J.V. (2021, December 15). Consensus Recommendations Wounds International 2015. Available online: https:\/\/www.woundsinternational.com\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1067\/mjd.2002.121739","article-title":"Venous leg ulcer: Incidence and prevalence in the elderly","volume":"46","author":"Margolis","year":"2002","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/j.1524-475X.2007.00328.x","article-title":"Early healing rates and wound area measurements are reliable predictors of later complete wound closure","volume":"16","author":"Cardinal","year":"2008","journal-title":"Wound Repair Regen."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How many interviews are enough? An experiment with data saturation and variability","volume":"18","author":"Guest","year":"2006","journal-title":"Field Methods"},{"key":"ref_5","first-page":"331","article-title":"Venous leg ulcer management in general practice\u2014Practice nurses and evidence based guidelines","volume":"41","author":"Weller","year":"2012","journal-title":"Aust. Fam. Physician"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta18570","article-title":"Venus IV (venous leg ulcer study IV)\u2014Compression hosiery compared with compression bandaging in the treatment of venous leg ulcers: A randomised controlled trial, mixed-treatment comparison and decision-analytic model","volume":"18","author":"Ashby","year":"2014","journal-title":"Health Technol. Assess."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.12968\/jowc.2016.25.Sup6.S1","article-title":"Management of patients with venous leg ulcer: Challenges and current best practice","volume":"25","author":"Franks","year":"2016","journal-title":"J. Wound Care"},{"key":"ref_8","first-page":"242","article-title":"An evidence-based algorithm for treating venous leg ulcers utilizing the cochrane database of systematic reviews","volume":"25","author":"Kimmel","year":"2013","journal-title":"Wounds"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1097\/WON.0000000000000622","article-title":"2019 guideline for management of wounds in patients with lower-extremity venous disease (LEVD)","volume":"47","author":"Kelechi","year":"2020","journal-title":"J. Wound Ostomy Cont. Nurs."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1016\/j.jvs.2014.04.049","article-title":"Management of venous leg ulcers: Clinical practice guidelines of the society for vascular surgery\u00ae and the american venous forum","volume":"60","author":"Passman","year":"2014","journal-title":"J. Vasc. Surg."},{"key":"ref_11","unstructured":"World Health Organization (2009). Self-Care in the Context of Primary Health Care, World Health Organization Regional Office for South-East Asia."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"8473","DOI":"10.3402\/qhw.v6i4.8473","article-title":"\u201cDelivering knowledge and advice\u201d: Healthcare providers\u2019 experiences of their interaction with patients\u2019 management of rheumatoid arthritis","volume":"6","author":"Bergsten","year":"2011","journal-title":"Int. J. Qual. Stud. Health Well-Being"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1097\/JCN.0000000000000447","article-title":"Self-care moderates the relationship between symptoms and health-related quality of life in heart failure","volume":"33","author":"Auld","year":"2018","journal-title":"J. Cardiovasc. Nurs."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/JCN.0b013e3182106299","article-title":"Relationship between self-care and health-related quality of life in older adults with moderate to advanced heart failure","volume":"27","author":"Buck","year":"2012","journal-title":"J. Cardiovasc. Nurs."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1177\/1474515114541730","article-title":"Trajectories of heart failure self-care management and changes in quality of life","volume":"14","author":"Lee","year":"2015","journal-title":"Eur. J. Cardiovasc. Nurs."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.hrtlng.2017.09.004","article-title":"Patterns of self-care and clinical events in a cohort of adults with heart failure: 1 year follow-up","volume":"47","author":"Lee","year":"2018","journal-title":"Heart Lung"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/JCN.0000000000000423","article-title":"Heart failure rehospitalization and delayed decision making","volume":"33","author":"Xu","year":"2018","journal-title":"J. Cardiovasc. Nurs."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1097\/JCN.0000000000000325","article-title":"Patterns of self-care in adults with heart failure and their associations with sociodemographic and clinical characteristics, quality of life, and hospitalizations","volume":"32","author":"Vellone","year":"2017","journal-title":"J. Cardiovasc. Nurs."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.jchf.2015.12.006","article-title":"Self-care and all-cause mortality in patients with chronic heart failure","volume":"4","author":"Kessing","year":"2016","journal-title":"JACC Heart Fail."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1037\/0003-066X.37.2.122","article-title":"Self-efficacy mechanism in human agency","volume":"37","author":"Bandura","year":"1982","journal-title":"Am. Psychol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1097\/JCN.0000000000000404","article-title":"First steps toward a theory of caregiver contribution to self-care in heart failure","volume":"32","author":"Vellone","year":"2017","journal-title":"J. Cardiovasc. Nurs."},{"key":"ref_22","first-page":"375","article-title":"The experiences of muslim family members of critically ill patients during end-of-life care in Saudi Arabia: A qualitative phenomenological study","volume":"29","year":"2018","journal-title":"Clin. Nurs. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1111\/inr.12194","article-title":"Caregiver burden for informal caregivers of patients with dementia: A systematic review","volume":"62","author":"Chiao","year":"2015","journal-title":"Int. Nurs. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3389\/fpubh.2016.00069","article-title":"Observations on the prevalence, characteristics, and effects of self-treatment","volume":"4","author":"Zhao","year":"2016","journal-title":"Front. Public Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.jhealeco.2008.10.005","article-title":"Mother\u2019s education and child health: Is there a nurturing effect?","volume":"28","author":"Chen","year":"2009","journal-title":"J. Health Econ."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Australian Institute of Health and Welfare (2014). Australia\u2019s Health 2014.","DOI":"10.12968\/eqhe.2014.1.20.6"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"E143","DOI":"10.2196\/jmir.9013","article-title":"Web-based patient education in orthopedics: Systematic review","volume":"20","author":"Dekkers","year":"2018","journal-title":"J. Med. Internet Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.jval.2015.12.001","article-title":"Patient-centered outcomes of medication adherence interventions: Systematic review and meta-analysis","volume":"19","author":"Conn","year":"2016","journal-title":"Value Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.pcd.2018.07.011","article-title":"Online patient education interventions in type 2 diabetes or cardiovascular disease: A systematic review of systematic reviews","volume":"13","author":"Woolley","year":"2019","journal-title":"Prim. Care Diabetes"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"\u017dulec, M., Rotar-Pavli\u010d, D., Puhari\u0107, Z., and \u017dulec, A. (2019). \u201cWounds home alone\u201d\u2014Why and how venous leg ulcer patients self-treat their ulcer: A qualitative content study. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16040559"},{"key":"ref_32","first-page":"224","article-title":"Assessing the readability of skin care and pressure ulcer patient education materials","volume":"30","author":"Wilson","year":"2003","journal-title":"J. WOCN"},{"key":"ref_33","first-page":"28","article-title":"Patient education strategies in dermatology part 2: Methods","volume":"1","author":"Zirwas","year":"2009","journal-title":"J. Clin. Aesthet. Dermatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.1111\/j.1365-2702.2012.04295.x","article-title":"The effectiveness of a health education intervention on self-care of traumatic wounds","volume":"22","author":"Chen","year":"2012","journal-title":"J. Clin. Nurs."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1097\/WON.0000000000000047","article-title":"The effect of patient education with telephone follow-up on wound healing in adult patients with clean wounds","volume":"41","author":"Chan","year":"2014","journal-title":"J. Wound Ostomy Cont. Nurs."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"E15678","DOI":"10.2196\/15678","article-title":"Wound care knowledge, attitudes, and practices and mobile health technology use in the home environment: Cross-sectional survey of social network users","volume":"8","author":"Kuan","year":"2020","journal-title":"JMIR MHealth UHealth"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1038\/s41394-019-0226-4","article-title":"Pressure ulcer knowledge, beliefs and practices in a group of South Africans with spinal cord injury","volume":"5","author":"Visser","year":"2019","journal-title":"Spinal Cord Ser. Cases"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1179\/2045772312Y.0000000016","article-title":"Potentially modifiable risk factors among veterans with spinal cord injury hospitalized for severe pressure ulcers: A descriptive study","volume":"35","author":"Guihan","year":"2012","journal-title":"J. Spinal Cord Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1111\/iwj.13281","article-title":"Patient education materials on pressure injury prevention in hospitals and health services in Victoria, Australia: Availability and content analysis","volume":"17","author":"Team","year":"2019","journal-title":"Int. Wound J."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Dorresteijn, J., Kriegsman, D., Assendelft, W., and Valk, G. (2014). Patient education for preventing diabetic foot ulceration. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD001488.pub5"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.ejvs.2020.03.053","article-title":"A systematic review of the impact of foot care education on self efficacy and self care in patients with diabetes","volume":"60","author":"Goodall","year":"2020","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"79","DOI":"10.12968\/jowc.2020.29.2.79","article-title":"Patient education for preventing recurrence of venous leg ulcers: A systematic review","volume":"29","author":"Shanley","year":"2020","journal-title":"J. Wound Care"},{"key":"ref_43","first-page":"16","article-title":"The effect of a patient education intervention on knowledge and venous ulcer recurrence: Results of a prospective intervention and retrospective analysis","volume":"63","author":"Gonzalez","year":"2017","journal-title":"Ostomy Wound Manag."},{"key":"ref_44","first-page":"CD008378","article-title":"Interventions for helping people adhere to compression treatments for venous leg ulceration","volume":"3","author":"Weller","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"75","DOI":"10.12968\/jowc.2005.14.2.26730","article-title":"Information leaflets for venous leg ulcer patients: Are they effective?","volume":"14","author":"Moore","year":"2005","journal-title":"J. Wound Care"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1111\/iwj.13172","article-title":"Education in people with venous leg ulcers based on a brochure about compression therapy: A quasi-randomised controlled trial","volume":"16","author":"Protz","year":"2019","journal-title":"Int. Wound J."},{"key":"ref_47","first-page":"690","article-title":"A multifaceted surgical site infection prevention bundle for cesarean delivery","volume":"38","author":"Scholz","year":"2019","journal-title":"Am. J. Perinatol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"O\u2019Kelly, S., and Moore, Z. (2017). Antenatal maternal education for improving postnatal perineal healing for women who have birthed in a hospital setting. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD012258"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1001\/jamadermatol.2018.3281","article-title":"Prescribed exercise with compression vs. compression alone in treating patients with venous leg ulcers","volume":"154","author":"Jull","year":"2018","journal-title":"JAMA Dermatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1111\/iwj.12868","article-title":"Factors associated with physical activity levels in people with venous leg ulcers: A multicentre, prospective, cohort study","volume":"15","author":"Smith","year":"2017","journal-title":"Int. Wound J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1111\/jan.13474","article-title":"Effects and associations of nutrition in patients with venous leg ulcers: A systematic review","volume":"74","author":"Barber","year":"2017","journal-title":"J. Adv. Nurs."},{"key":"ref_52","unstructured":"Croatian Burreau of Statistics (2015). Indicators of Poverty And Social Exclusion, 2015\u2014Final Results, Croatian Burreau of Statistics."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1258\/phleb.2010.010082","article-title":"A pilot study of the development and implementation of a \u2018best practice\u2019 patient information booklet for patients with chronic venous insufficiency","volume":"26","author":"Bobridge","year":"2011","journal-title":"Phlebol. J. Venous Disease."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1097\/WON.0000000000000238","article-title":"Educational intervention for nutrition education in patients attending an outpatient wound care clinic","volume":"43","author":"Green","year":"2016","journal-title":"J. Wound Ostomy Cont. Nurs."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.ejvs.2013.04.015","article-title":"Bandages or double stockings for the initial therapy of venous oedema? A randomized, controlled pilot study","volume":"46","author":"Mosti","year":"2013","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1258\/phleb.2011.011038","article-title":"Compression stockings with moderate pressure are able to reduce chronic leg oedema","volume":"27","author":"Mosti","year":"2012","journal-title":"Phlebology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1258\/phleb.2008.008009","article-title":"Inelastic compression increases venous ejection fraction more than elastic bandages in patients with superficial venous reflux","volume":"23","author":"Mosti","year":"2008","journal-title":"Phlebology"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.pec.2006.09.008","article-title":"Deccache patient empowerment in theory and practice: Polysemy or cacophony?","volume":"66","author":"Aujoulat","year":"2007","journal-title":"Patient Educ. Couns."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.jtv.2020.08.006","article-title":"Nurse-led patient education for persons suf-fering from a venous leg ulcer in outpatient\u2019s clinics and homecare settings: A scoping review","volume":"29","author":"Bobbink","year":"2020","journal-title":"J. Tissue Viability"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/8\/4657\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:52:41Z","timestamp":1760136761000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/8\/4657"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,12]]},"references-count":59,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["ijerph19084657"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19084657","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,12]]}}}