title: Supporting adherence and healthy lifestyles in leg ulcer patients: systematic development of the Lively Legs program for dermatology outpatient clinics.
abstract: OBJECTIVE
  The objective of our project was to develop a lifestyle program for leg ulcer patients at outpatient clinics for dermatology.
  
  
  METHODS
  We used the intervention-mapping (IM) framework for systematically developing theory and evidence based health promotion programs. We started with a needs-assessment. A multidisciplinary project group of health care workers and patients was involved in all five IM steps; formulating proximal program objectives, selecting methods and strategies, producing program components, planning for adoption and implementation and planning for evaluation. Several systematic literature reviews and original studies were performed to support this process.
  
  
  RESULTS
  Social Cognitive Theory was selected as the main theory behind the program 'Lively Legs' and was combined with elements of Goal-Setting Theory, the precaution adoption model and motivational interviewing. The program is conducted through health counseling by dermatology nurses and was successfully pre-tested. Also, an implementation and evaluation plan were made.
  
  
  CONCLUSIONS
  Intervention mapping helped us to succeed in developing a lifestyle program with clear goals and methods, operational strategies and materials and clear procedures.
  
  
  CONCLUSIONS
  Coaching leg ulcer patients towards adherence with compression therapy and healthy lifestyles should be taken on without delay. Systematic development of lifestyle programs for other patient groups should be encouraged.
authors.affiliation: Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, Kwazo 229, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. m.heinen@kwazo.umcn.nl
authors.forename: Maud M
authors.initials: MM
authors.lastname: Heinen
authors.forename: L Kay
authors.initials: LK
authors.lastname: Bartholomew
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Peter
authors.initials: P
authors.lastname: van de Kerkhof
authors.forename: Theo
authors.initials: T
authors.lastname: van Achterberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration* / Q000523:psychology; D001458:Bandages; D003376:Counseling / Q000458:organization & administration*; D005081:Exercise Therapy / Q000458:organization & administration; D005240:Feasibility Studies; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007871:Leg Ulcer / Q000517:prevention & control* / Q000523:psychology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009042:Motivation; D020380:Needs Assessment; D024802:Nurse's Role; D015403:Nursing Evaluation Research; D010349:Patient Compliance / Q000523:psychology*; D016730:Program Development; D015397:Program Evaluation; D011582:Psychological Theory; D011788:Quality of Life