City Research Online

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)

McKeown, E., McGraw, C., Holder, P. , Shand, J. & Hirani, S. ORCID: 0000-0002-1577-8806 (2022). 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). doi: 10.2196/preprints.36517


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.

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.

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.

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.

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. Clinical Trial: Not applicable

Publication Type: Other (Preprint)
Publisher Keywords: Pressure ulcers, Informal carers, Smartphone apps, mHealth, Educational technology, Health education
Subjects: H Social Sciences > HM Sociology
Q Science > QA Mathematics > QA75 Electronic computers. Computer science
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RT Nursing
Departments: School of Health & Psychological Sciences
School of Health & Psychological Sciences > Healthcare Services Research & Management
SWORD Depositor:


Add to AnyAdd to TwitterAdd to FacebookAdd to LinkedinAdd to PinterestAdd to Email


Downloads per month over past year

View more statistics

Actions (login required)

Admin Login Admin Login