Acceptability and impact of an educational app (iCare) for informal carers looking after people at risk of pressure ulceration: A mixed methods pilot study (Preprint)
Authors: McKeown Eamonn , McGraw Caroline , Holder Pru , Shand Jenny , Hirani Shashivadan 
Published: January 2022

BACKGROUND

Pressure ulcers are areas of skin damage resulting from sustained pressure. Informal carers play a central role preventing pressure ulcers amongst older and disabled people living at home. Research highlights the paucity of pressure ulcer training for informal carers and suggests pressure ulcer risk is linked to high levels of carer burden.

OBJECTIVE

This pilot study evaluated a smartphone app with a specific focus on pressure ulcer prevention education for informal carers. The app was shaped by the principles of micro-learning. The study aimed to explore carer perspectives on the acceptability of the app and determine whether the app increased carers’ knowledge and confidence in their caring role.

METHODS

In this concurrent mixed methods study, participants completed quantitative questionnaires at baseline, and at the end of weeks 2 and 6, which examined caregiving self-efficacy, preparedness for caregiving, caregiver strain, and pressure ulcer knowledge, as well as app acceptability and usability. A sub-sample of participants took part in a ‘think aloud’ interview in week 1 as well as semi-structured interviews at the end of weeks 2 and 6.

RESULTS

In total, 23 (71.9%) participants completed the questionnaire at the end of week 2 and 16 (50%) at the end of week 6. For the qualitative component, 21 carers participated in ‘think aloud’ interviews, 18 went on to participate in semi-structured interviews at the end of week 2, and 13 at the end of week 6.
Pressure ulcer knowledge scores significantly changed (F(1, 6.112)=21.624, p<0.001) from baseline(mean=37.5, se=2.926) to the second follow-up (mean=59.72, se=3.985). In relation to the qualitative data, the theme ‘I’m more careful now and would react to signs of redness’ captured participants’ reflections on the new knowledge they had acquired, the changes they had made to their caring routines, their increased vigilance for signs of skin damage, and their intentions towards the app going forwards. There were no significant results pertaining to improved preparedness for caregiving or caregiving self-efficacy or related to the caregiver strain index. Participants reported relatively high usability scores on a 0-100 scale (mean=69.94, SD=18.108). The app functionality and information quality were also rated relatively highly on a 0-5 scale (mean=3.84, SD=0.704; mean=4.13, SD=0.452). Two themes pertaining to acceptability and usability were identified, ‘When you’re not used to these things, they take time to get the hang of’, and ‘It’s not a fun app but it is informative’. All participants liked the micro-learning approach.

CONCLUSIONS

The iCare app offers a promising way to convey information and improve informal carers’ pressure ulcer knowledge. However, to better support cares, the findings may reflect the need for future iterations of the app to employ more interactive elements, and the introduction of gamification and customisation to user preferences.

CLINICALTRIAL

Not applicable