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

Abstract

Background Mobile health applications can offer tailored self-management support to individuals living with chronic health conditions. However, there are several challenges to the adoption of these technologies in practice. Co-design is a promising approach to overcoming some of these challenges by enabling the development of solutions that meet the actual needs and preferences of the relevant stakeholder groups. Objective Taking spinal cord injury as a case in point, the overall objectives of this study were to identify the perceived benefits of a co-designed self-management app that could promote its uptake and to explore the factors that may impede adoption. Methods We adopted a qualitative research approach guided by the Technology Acceptance Model. Data were collected through semistructured interviews with individuals with spinal cord injury (n=15) and two focus groups with health care professionals specialized in spinal cord injury (n=7, n=5). Prior to the interviews and focus groups, study participants were given time to explore the app prototype. All interviews were transcribed verbatim and analyzed using inductive thematic analysis. Results Findings of our analysis indicate that study participants perceived the app prototype as potentially useful for supporting individuals with spinal cord injury in preventing pressure injuries. In particular, we identified three concrete use cases highlighting the benefits of the app for different audiences: (1) a companion for newly injured individuals, (2) an emergency kit and motivational support, and 3) a guide for informal caregivers and family members. We also uncovered several challenges that might impede the adoption of the self-management app in practice, including (1) challenges in motivating individuals to use the app, (2) concerns about the misuse and abuse of the app, and (3) organizational and maintenance challenges. Conclusions This study adds to a growing body of research that investigates individuals’ adoption and nonadoption behavior regarding mobile health solutions. Building on earlier work, we make recommendations on how to address the barriers to the adoption of mobile health solutions identified by this study. In particular, there is a need to foster trust in mobile health among prospective users, including both patients and health care professionals. Moreover, increasing personal relevance of mobile health solutions through personalization may be a promising approach to promote uptake. Last but not least, organizational support also plays an instrumental role in mobile health adoption. We conclude that even though co-design is promoted as a promising approach to develop self-management tools, co-design does not guarantee adoption. More research is needed to identify the most promising strategies to promote the adoption of evidence-based mobile health solutions in practice.

Methods for Human-Centered eHealth Development: Narrative Scoping Review

“…Consequently, interviews can have a broad range of goals. Examples include identifying points of improvement for a current situation such as treatment of forensic psychiatric patients [ 96 ]; analyzing target or risk groups in, for example, tick bites [ 100 ]; identifying points of improvement for prototypes or existing (eHealth) interventions according to end users or design experts [ 83 , 84 ]; identifying potential barriers and facilitators for implementation later in the process, such as high costs and required skills training [ 78 , 96 ]; describing a current behavior and its determinants [ 91 ]; collecting experiences of participants after letting them try out an app in real life [ 83 ]; and generating or validating values and requirements [ 15 , 28 , 98 , 103 ].…”

“…However, despite the benefits, including these types of target groups was found to be challenging, mostly because participating in relatively long, in-depth interviews requires a fairly high level of cognitive abilities such as attention and memory. Consequently, researchers should account for the characteristics of their target groups by, for instance, keeping the interviews as short as possible [ 78 , 128 ]. Another option is the use of concrete examples of eHealth technologies to account for response or recollection biases [ 24 , 52 , 97 , 121 , 123 ].…”

“…Second, although interviews can yield valuable results, a limitation is that they can offer a 1-sided picture of stakeholders’ needs and wishes regarding eHealth. Selection bias can result in a sample that is overly positive or negative [ 78 , 128 ]. To overcome these issues, which are related to generalizability, multiple authors recommended that interviews be combined with other methods in a multi-method or mixed methods approach [ 24 , 40 , 52 , 54 , 69 , 78 , 96 , 97 , 100 , 102 , 108 , 109 , 116 , 118 , 120 , 124 , 126 ].…”

“…Selection bias can result in a sample that is overly positive or negative [ 78 , 128 ]. To overcome these issues, which are related to generalizability, multiple authors recommended that interviews be combined with other methods in a multi-method or mixed methods approach [ 24 , 40 , 52 , 54 , 69 , 78 , 96 , 97 , 100 , 102 , 108 , 109 , 116 , 118 , 120 , 124 , 126 ]. This could be done by combining interviews with a small sample size with a questionnaire with a larger sample size.…”

Designing the Optimal Digital Health Intervention for Patients’ Use Before and After Elective Orthopedic Surgery: Qualitative Study

“…Combining goal setting with performance feedback and the review of goals (akin to milestones within the recovery journey) has been associated with both short-and long-term intervention effectiveness [39,40]. Personalized and tailored feedback on these goals could be acknowledged as relevant and actionable, as opposed to generic advice [41]. By integrating digital strategies to help define goals within recovery, orthopedic patients may feel better supported and motivated to engage in health behavior change.…”