Bridging the gap between awareness and behaviour in pressure injury prevention: a cross-sectional survey of self-management in people with spinal cord injury

To examine how self-management attitudes, illness perceptions and preventive behaviours relate to adherence to pressure injury prevention in people with spinal cord injury (PwSCI) using a theory-informed framework. A cross-sectional survey of 184 wheelchair-users with a SCI within community and specialist SCI centres. Preventive behaviours (pressure relief, skin inspection), self-management domains (concordance, perceived benefits, perceived negatives, practical barriers) and illness perceptions (mBIPQ) were assessed. Associations and subgroup differences by pressure injury history and education were analysed. Participants reported high perceived benefit of pressure-relief activities (4.02 ± 0.62) but only moderate concordance (3.05 ± 0.79) and persistent practical barriers (3.22 ± 0.75), indicating a gap between awareness and routine behaviour. Concordance was positively associated with pressure-relief activity (r = 0.49, p < 0.001) and negatively with barriers (r = −0.56, p < 0.001). Prior pressure injury education and experience were associated with more positive attitudes and greater engagement. Older age (≥ 55 years), but not injury duration, was associated with higher adherence. Despite high awareness, adherence to preventive routines remains constrained by perceptual and practical barriers. This study provides quantitative evidence explaining why awareness does not consistently translate into preventive behaviour, highlighting the need to address real-world barriers beyond education alone.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.© 2026 The Author(s). International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd