Qualitative study of principles pertaining to lifestyle and pressure ulcer risk in adults with spinal cord injury

Abstract

Purpose. The aim of this article is to identify overarching principles that explain how daily lifestyle considerations affect pressure ulcer development as perceived by adults with spinal cord injury (SCI).

Method. Qualitative in-depth interviews over an 18-month period with 20 adults with spinal injury and a history of pressure ulcers were conducted using narrative and thematic analyses.

Results. Eight complexly interrelated daily lifestyle principles that explain pressure ulcer development were identified: perpetual danger; change/disruption of routine; decay of prevention behaviors; lifestyle risk ratio; individualization; simultaneous presence of prevention awareness and motivation; lifestyle trade-off; and access to needed care, services and supports.

Conclusions. Principles pertaining to the relationship between in-context lifestyle and pressure ulcer risk underscore previous quantitative findings, but also lead to new understandings of how risk unfolds in everyday life situations. Pressure ulcer prevention for community-dwelling adults with SCI can potentially be enhanced by incorporating principles, such as the decay of prevention behaviors or lifestyle trade-off, that highlight special patterns indicative of elevated risk. The identified principles can be used to theoretically drive future research or to guide innovative lifestyle-focused intervention approaches. Public policies that promote short-term preventive interventions at critical junctures throughout a person's life should be considered.

Keywords:

• Spinal cord injury
• pressure ulcers
• qualitative research
• lifestyle

Acknowledgements

This study was supported by the National Institute on Disability and Rehabilitation Research, US Department of Education (grant no. H133G000062). We thank Kathy Gross, MA; Rod Adkins, PhD; and Debra Uhles-Tanaka, MA for their participation in the original grant. For their work in the data analysis and interpretation we would like to acknowledge Eric Asaba, PhD, Aaron Eakman, PhD, and Elizabeth Pyatak, MA. We thank Paul Bailey, MSc, and Faryl Saliman Reingold, MA for their help in generating participant profiles. We also thank our consumer board: Gabriel Cardiel, Jesse Murillo, Forrest Pendleton, and Ken Younger.