What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors.

With the recognition of health-related quality of life (HRQL) as an important and relevant outcome in pressure ulceration, it is important to gain better understanding of the complex relationship among the various factors that affect it. A problem with existing literature in this area is that the impact of having a pressure ulcer on HRQL is combined conceptually with contributory factors which may influence outcome. This study identified contributory factors affecting pressure ulcer-related HRQL and explored interrelationships between factors based on views of adults with pressure ulcers. We obtained patient-reported qualitative data through semi-structured interviews with 30 patients with pressure ulcers recruited from hospital and community settings around England and Northern Ireland. Patients described how pressure ulcers affected their lives by recounting specific relevant events. Events (patient-reported issues) were sorted into categories and data framework analysed to produce a taxonomy of contributory factors. Inter-rater reliability established the extent of agreement between two independent raters. We identified 16 contributory factors, into two theme taxonomy: experience-of-care and individual-patient factors, defined by descriptive components. Our taxonomy is a comprehensive theoretical model of factors that contribute to pressure ulcer-related HRQL. We have also identified further research priorities to inform clinical practice.