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Table 4. Association between adherence and perceived control of lymphedema overall
Adherence Well-controlled or improving Fluctuating or worsening Total
Daily > 9 h 17 8 25
< 7 days or < 9 h 8 15 23
Total 25 23 48
r = 0.304; 95%CI: 0.051-0.564; P = 0.021

Table 5. Association between adherence and perceived control for those with moderate to severe lymphedema
Lymphedema severity Adherence Well-controlled or improving Fluctuating or worsening Total
Moderate Daily >9 h 11 9 20
< 7 days or < 9 h 3 13 16
Total 14 22 36
r = 0.396; 95%CI: 0.043-0.745; P = 0.047

and why they do not wear the sleeve in specific circumstances (e.g., social situations and weather), and the
impact of wearing the sleeve on daily function:
1. What are the benefits for you with wearing the sleeve?
2. Does anything make it easier or harder for you to wear a sleeve for 12 hours a day?
3. How do you feel about wearing your compression sleeve?
4. What is your experience/perspective on times when you don’t wear your sleeve?
4.a. Do you have strategies to manage your lymphedema in these situations?

Sample supporting quotations are provided in each section to illustrate participants’ perspectives.

Benefits of wearing the garment
Across all focus group sessions, the primary identified benefit of wearing the sleeve was to reduce or
control the lymphedema. Other reported benefits included symptom management (e.g., reduced pain/
discomfort, tension, and heaviness in limb), protection of the skin (e.g., reduced risk of damaging the skin),
preventing/reducing episodes of cellulitis, and keeping the shape/contour of the limb.
- “I am pretty good about wearing the sleeve, because I know it manages the swelling.”
- “I know I need to wear my sleeve, so I do.”

Facilitators to regular use of the sleeve
Facilitators to regular use of daytime compression included using adaptive strategies (e.g., using older
sleeves for gardening or dirty tasks), having more garment options (e.g., colors to match outfits and lower
compression garment options for exercise), and having the money or medical insurance to help cover costs
of extra garments (e.g., less washing and a clean garment for each work day). The majority of participants
reported that wearing their garment was a habit and that they had accepted the need to wear it.
- “It is part of my dress every day.”
- “I never worry about social situations, it is who I am; never think about it.”
- “I do get asked a lot by children, sometimes adults, I explain simply. My granddaughter who is 18 months
keeps me honest - she notices if I haven’t got it on.”
- “Nice to dress it up and have fun with it. If I have to wear it, I want it to be a fashion statement!”

Barriers to regular use of the sleeve
Five key themes were identified representing the primary barriers to regular use of the compression sleeve
or reasons for non-use: discomfort, negative emotions, interference with function, social situations and
visibility, and alternative management strategies.