Co-designing a Self-Management App Prototype to Support People With Spinal Cord Injury in the Prevention of Pressure Injuries: Mixed Methods Study

Abstract

<jats:sec> <jats:title>Background</jats:title> <jats:p>Spinal cord injury is a complex chronic health condition that requires individuals to actively self-manage. Therefore, an evidence-based, self-management app would be of value to support individuals with spinal cord injury in the prevention of pressure injuries.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>The main objectives of this study were to (1) establish a co-design approach for developing a high-fidelity prototype app for the self-management of individuals with spinal cord injury, (2) design the prototype that resulted from this process, and (3) conduct the first usability assessment of the prototype app.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>We adopted a co-design approach to develop an evidence-based app prototype. Starting from a preliminary content model (based on clinical guidelines for the prevention of pressure injuries) and three research-based user personas, we conducted an ideation workshop involving individuals with spinal cord injury and health care professionals. The ideation workshop formed the basis for two consecutive design sprints. The result of this co-design phase was an interactive app prototype. The prototype was evaluated in two rounds of usability testing (N=4 and N=15, respectively) using a combination of qualitative and quantitative methods.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The co-design process resulted in a high-fidelity prototype with two key components: a self-management component and a communication component. The final prototype included a combination of features to support individuals with spinal cord injury in the prevention of pressure injuries, namely a smart camera, pressure injury diary, expert consultation, reminders, and knowledge repository. Findings of the usability testing showed that most participants navigated the app fluently with little back and forth navigation and were able to successfully complete a set of assigned tasks. These positive results are supported by the average system usability score achieved (78.5/100; range 47.5-95.0) and our qualitative analysis of the semistructured interviews. Despite an overall positive evaluation of the app prototype, we identified areas for improvement (eg, inclusion of a search function).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Individuals with spinal cord injury often need to navigate competing interests and priorities, paired with uncertainty about the accuracy and relevance of clinical recommendations. Understanding what matters to individuals with spinal cord injury can help guide the design of behavioral interventions that are useful and acceptable to these individuals in their daily lives. This study shows that involving individuals with spinal cord injury and health care professionals in co-designing a self-management app can foster knowledge cocreation at the intersection of lived experience, medical expertise, and technical solutions.</jats:p> </jats:sec>

Opportunities and Challenges of a Self-Management App to Support People With Spinal Cord Injury in the Prevention of Pressure Injuries: Qualitative Study

“…Figure 1 illustrates the methodological approach of the overall project. Detailed descriptions of the app development process have been published elsewhere [ 5 , 28 ]. This paper focuses on assessing the perceived utility and acceptance of the app prototype that resulted from the previous phases of this project.…”

“…Both individuals with SCI and health care professionals were given time to explore the app prototype (see Multimedia Appendix 1 for screenshots of the app prototype) prior to the interviews/focus groups. People with SCI first took part in a usability test [ 28 ] that allowed them to explore the app prototype in more depth. Healthcare professionals received a brief introduction to the main functionalities and elements of the app by the first author (JA).…”

“…In this paper, we focused our analysis on identifying concrete benefits of the app that could promote its uptake and exploring the factors that may impede its adoption into practice. Results of a preliminary usability test of the co-designed self-management app are reported elsewhere [ 28 ].…”

“…The interactive web-based app prototype evaluated in this study is the result of a multistage co-design process [ 5 , 28 ]. It includes five main features: (1) a smart camera, (2) a pressure injury diary, (3) an expert consultation, (4) reminders, and (5) a knowledge repository.…”

“…Within the scope of the overall project, we aimed to involve a balanced sample of participants in terms of age, gender, lesion level for people with SCI, and health care professionals’ expertise [ 28 ]. Prospective participants were identified through the local rehabilitation center (Swiss Paraplegic Center), patient association (Swiss Paraplegic Association), and home care provider specialized in SCI (Parahelp).…”