No Pressure!: Designing Mobile Interventions to Improve Pressure Relief Adherence for Individuals with Spinal Cord Injury through Diary Studies

Abstract

Pressure injuries, otherwise known as decubitus ulcers or ‘bedsores’, affect an estimated 1 to 3 million people in the United States each year (Mondragon and Zito). Individuals with spinal cord injury (SCI) are a particularly vulnerable group to pressure injuries due to the reduced mobility of their wheelchair-bound lifestyle and partial loss of sensation. As a preventive measure, individuals with SCI are taught to do regular pressure reliefs throughout their day to offload pressure away from areas of high pressure. However, as with many health maintenance activities, pressure-relieving exercises are often neglected or easily forgotten. This thesis explores how mobile interventions can be designed to improve pressure relief adherence by individuals with SCI.

To this end, literature on habit formation and adherence apps was studied to inform the design of a prototypical pressure relief notification system, which was tested with individuals with SCI. A 10-day diary study was conducted to capture their experiences in real-time, resulting in a collection of quantitative and qualitative data. The analysis led to a set of key considerations for designing such mobile interventions: 1) technology with a human touch – through humour and positive reinforcement; 2) identification of specific user groups and use cases; 3) personalisation of settings and providing flexibility for universal lifestyles and needs. These will inform the further development of this mobile intervention to improve pressure relief adherence by individuals with SCI, and ultimately help reduce pressure injury incidences.

The field of mobile health interventions continues to grow with the development of technology. The resulting human-centred design considerations and use of diary study methods from this thesis can be extended to other preventive health applications through mobile interventions, such as that of medication adherence or exercise.