Background Although varied interventions are used to prevent venous leg ulcers (VLUs), compression therapy remains the gold standard for VLU prevention and treatment [1][2][3] . However, non-compliance remains an issue. What is it then that makes it difficult for patients to comply? Subsequently, this review paper aims to explain the reasons and contributing factors that attribute to patients' non-compliance to compression therapy with a view of finding strategies that can increase adherence.Method A literature search was undertaken using the terms 'compression therapy', 'compliance' and 'venous leg ulcers'. Articles that reported reasons for non-compliance or adherence to compression therapy were included. Seventeen articles met the inclusion criteria. The reasons for non-compliance were tabulated and subjected to thematic analysis. ResultsFive determinant themes regarding patients' reasons for non-compliance with compression therapy emergedpain and discomfort, psychosocial issues, knowledge deficit, physical limitations, and financial issues.Discussion Compliance with compression is the key to achieving wound healing in patients with VLUs but compliance rate remains low. Consequently, effort needs to be made by healthcare professionals (HCPs) to improve compliance and therapeutic relationships through holistic patient assessment that addresses their experiences and values their individualism, health beliefs, lifestyle and social networks 4,5 . Further studies to identify intervention strategies that can increase their compliance are required.What is known on this topic?• Evidence-based guidelines for the prevention and management of VLUs recommend compression therapy as the gold standard treatment strategy for VLUs.• Uptake and compliance with compression therapy promotes VLU healing and can prevent recurrence when compared to no compression.• Many patients cannot tolerate or comply to compression therapy. What this paper adds• Being non-judgemental and supportive allows HCPs to monitor patients' beliefs and health behaviours about compression therapy, and this also assists them in planning individualised intervention strategies that can increase compliance rates.