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Page 4 of 14 Al Onazi et al. Plast Aesthet Res 2020;7:23 I http://dx.doi.org/10.20517/2347-9264.2019.74

(MM) facilitated the focus group discussions at both locations, with a second researcher in attendance at
each session in Edmonton (MAO) and Calgary (ND).

Data analysis
The survey results were analyzed quantitatively using the means and standard deviations for continuous
variables, and frequencies and percentages for nominal variables. We also examined the association
between adherence to daytime compression and perceived control of lymphedema, overall and by
lymphedema severity, using a Chi square correlation coefficient. All focus group tapes were audio recorded
and transcribed verbatim by the research team. ID was used to guide the process of capturing patterns and
themes about perceptions and perspectives related to the participants’ adherence to daytime compression.
Data analysis was based on a thematic analytic approach and followed the processes as described by Braun
[22]
and Clarke . The data were examined line by line by the researchers independently to identify patterns
and key themes with sample quotations from the data. Codes for similar meanings and highlighted terms
were developed, examined, and refined as necessary to identify the most expressive codes to represent the
participants’ voice. The researchers then discussed and reviewed the independently coded data together,
until a consensus on themes was reached. Conceptual themes were inductively originated from the analysis,
[22]
by first generating initial codes, followed by subthemes, and finally by generating an overarching theme .
An additional step was taken to map the qualitative data back to the TDF. Any responses or comments that
did not answer the specific question were not included in the analysis.

Ethical considerations
Ethical approval was obtained from the Health Research Ethics Board of Alberta: Cancer Committee for
this additional follow-up component of the LYNC study. All participants provided amended informed
consent. Each participant was coded by a study number to protect her identity.

RESULTS
Questionnaires were completed by 48 of 52 participants who responded to our invitation to take part in the
survey, for an overall completion rate of 92% [Figure 1]. Twenty-three of the survey respondents (48%) took
part in one of the five subsequent focus group sessions. Four focus group sessions were held in Edmonton (n
= 18) and one was held in Calgary (n = 5).

Quantitative survey results
The mean age of participants was 65 years (range 39-82). The majority of participants (80%) described
their general health as “good” or “very good”. More than half of the participants reported a duration of
lymphedema of greater than six years (58%), and that the extent of their swelling was “moderate” (69%).
Most commonly, participants reported the status of their lymphedema as “well controlled” (38%) or
“fluctuating” (44%), with 34% stating they were bothered by their lymphedema “moderately” or higher. Of
the 12 participants (25%) reporting “slight/mild” swelling, only one (5%) stated she was bothered by her
lymphedema more than “a little bit” [Table 1].

Twenty-eight participants (58%) reported using their sleeve daily, and 17 (35%) reported using the garment
for > 12 h per day. When we examined adherence to both days and hours, only 15 participants (31%)
reported adhering to wearing the garment > 12 h every day.

Survey findings suggest that the vast majority of participants (98%) have good knowledge about the
rationale for, and the benefits of, wearing the compression sleeve [Table 2]. Forty-three participants (90%)
reported that their compression sleeve helped them to manage their lymphedema. Most participants
understood the different types (85%), compression levels (77%), and recommended number of hours to