Adherence to skincare self-management for pressure ulcer prevention in spinal cord injury through the lens of the health belief model -a qualitative descriptive study

Background:
Pressure ulcers (PrUs) are among the most severe secondary complications for individuals with spinal cord injuries (PwSCI) due to lifelong risk factors, including sensory and motor impairments and prolonged sitting in wheelchairs (Morrow, 2024). PrUs affect 45–95% of PwSCI (Soggard, 2023), accounting for 25% of healthcare costs in this population, with treatment costs ranging from £1,214 to £14,108 per case in the UK (Dealey, 2012; Kruger et al., 2013).
Self-Management and Challenges:
Skincare education is provided in hospitals post-injury, promoting self-management strategies such as repositioning, skin monitoring, and specialised equipment use (Liu et al., 2021; Fogelberg et al., 2016). However, adherence to skincare self-manangement is reported poor after the discharge (Schofield, 2013, Liu et al 2024.; Ghaisas et al., 2015). PrUs remain high incidence and the only secondary condition consistently linked to increased mortality risk in PwSCI (Morrow et al., 2024).
Study Aim:
To explore PwSCI’s views on adherence of skincare self-management for PrU prevention through the Lens of the Health Belief Model.
Methods:
Ethics approval was obtained from Middlesex University and National Research Ethics Committee (REC/HRA). Semi-structured interviews were conducted with 12 PwSCI, aged 23–68 years, injury levels ranging from C4 to T12, and injury durations of 1 to 35 years. Interviews were audio-recorded, transcribed verbatim, and analysed thematically.
Findings:
Most participants had a history of PrUs, commonly located on the sacrum/ ischial tuberosities. The analysis identified four key themes influencing skincare self-management among PwSCI. 1) Perceived susceptibility and severity were heightened through rehabilitation education or personal PrU experience, motivating preventive behaviours. 2) Perceived benefits of skin checks, repositioning, and pressure-relieving equipment reinforced adherence, though barriers such as sensory loss, limited mobility, healthcare delays, and mental health challenges hindered self-management. 3) Cues to action, including caregiver involvement and structured reminders improved adherence, while self-efficacy was strengthened through routine-building and external support. These findings highlight the need for personalised education, structured adherence strategies, psychological support and caregiver training to enhance PrU prevention.
Implications for Practice:
Findings support developing personalised skincare programs to improve skincare self-management, enhance adherence, and reduce PrU incidence, ultimately lowering healthcare costs.