Psychosocial factors impacting community-based pressure ulcer prevention: A systematic review

BACKGROUND

Pressure ulcers are a major health concern. They have a significant impact on the healthcare system and individuals, reducing quality of life across several domains. In community settings, self-management behaviours are central to their prevention. However, adherence with pressure ulcer prevention guidelines remains low, with little evidence guiding the relationship between patients and healthcare professionals to establish a concordant partnership.

OBJECTIVE

To synthesise evidence on factors contributing to community-based pressure ulcer prevention using the Theoretical Domains Framework and the Capability, Opportunity, Motivation, Behaviour (COM-B) model of behaviour.

DESIGN

Mixed methods systematic review and narrative synthesis.

METHOD

Systematic searches were conducted in the CINAHL, Cochrane, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science databases on 14th December 2022. Studies were eligible if they contained data on the factors associated with adherence and concordance with pressure ulcer prevention guidelines in the community for patients, caregivers, and healthcare professionals. Methodological quality was assessed using the Hawker tool. Findings were synthesised using the Theoretical Domains Framework. The resulting themes were mapped onto the Capability, Opportunity, Motivation, Behaviour (COM-B) model.

RESULTS

Thirty studies were included in the review, including quantitative, qualitative, and mixed methods research. The synthesis identified 12 of the 14 Theoretical Domains Framework domains, with knowledge, social influences, beliefs about consequences, and beliefs about capabilities the most prevalent. Although knowledge appears to be an important contributor to adherence with prevention guidelines, knowledge alone does not appear sufficient to achieve concordance. A concordant relationship was facilitated by healthcare professionals' knowledge, motivation to work alongside patients and their priorities, and interpersonal skills to build rapport and trust, whilst barriers included lack of healthcare professional skills to navigate sensitive issues, paternalistic views of patient compliance and organisational processes that impact building rapport.

CONCLUSIONS

Several psychosocial factors may affect the ability to achieve concordance between individuals, caregivers and healthcare professionals with pressure ulcer prevention guidelines in the community. However, data regarding the efficacy of behaviour change interventions targeting these constructs is limited, with further research required to guide intervention development in this area.

Training program for caregivers to prevent pressure ulcers among elderly residents at geriatric homes

Objectives

Pressure ulcer (PU) is one of the most common problem among the bedridden elderly and has significantly more burden on elderly and caregivers. This study is aimed to evaluate the effects of the training program for caregivers to prevent PUs among elderly residents at geriatric homes.

Methods

A quasi-experimental design was used to carry out the current study. A purposive sample comprised of all formal (39 nurses) or informal caregivers (39) and all immobilized elderly residents (35) who are found in all geriatric centers in Helwan district. A structured questionnaire was used to assess caregivers’ socio-demographic characteristics, knowledge, attitude, and observational checklists for their practice for prevention of PU at pre- and posttest and during follow-up.

Results

After the training program, there were improvements in the level of knowledge, practice, and positive attitude of caregivers about PU prevention with a statistically significant difference between pre-, post-, and follow-up training programs (P < 0.001).

Conclusions

The study revealed that the training program seemed to change the knowledge, practice, and attitude of the subjects to PU prevention. This, in turn, implies that adequate knowledge affects directly the elderly caregivers’ attitudes as well as practice for prevention could be important in reducing the burden of PU among the elderly. Thus, conducting a training program for caregivers at different geriatric homes about caring skills for elders can prevent PU, and using spontaneous reposition is very effective to prevent PUs.

Convergent Validity of Three Pressure Injury Risk Assessment Scales: Comparing the PPRA-Home (Pressure Injury Primary Risk Assessment Scale for Home Care) to Two Traditional Scales

Purpose

The Pressure Injury Primary Risk Assessment Scale for Home Care (PPRA-Home) was developed to predict pressure injury risk in geriatric individuals requiring long-term care in home settings. This study aimed to compare the convergent validity of the PPRA-Home to that of the two other standardized pressure injury prevention scales: the Braden and Ohura-Hotta (OH) scales.

Methods

A multicenter, cross-sectional study was conducted with 34 home-based geriatric support service providers located in five Japanese districts. The study included 69 participants (30 had a pressure injury and 39 did not) who were at classified at care levels of 1 through 5 under Japan’s long-term care insurance system. Care managers served as assessors for the PPRA-Home, while physicians or certified expert nurses served as assessors for the Braden and OH scales. Convergent validity was investigated by examining correlation coefficients between total scores on the PPRA-Home and the other two scales. Receiver operating curve analysis was used to quantify each scale’s accuracy for the two groups: those with and without a pressure injury.

Results

The PPRA-Home was found to be negatively correlated with the Braden scale (r=−0.79, p<0.05), and positively correlated with the OH scale (r=0.58, p<0.05). The area under the curve (AUC) for the PPRA-Home, Braden scale, and OH scale were 0.737, 0.814, and 0.794, respectively. A PPRA-Home cutoff score of 4 had a sensitivity of 63.3% and specificity of 81.6%.

Conclusion

The AUC for the PPRA-Home as scored by care managers was similar to those of the Braden and OH scales as scored by physicians or expert nurses. More research on the PPRA-Home’s content and predictive validity is required.

Inter-Rater Reliability of a Pressure Injury Risk Assessment Scale for Home Care: A Multicenter Cross-Sectional Study

Purpose

The aim of the current study was to assess the inter-rater reliability and agreement of the Pressure Injury Primary Risk Assessment Scale for Home Care (PPRA-Home), a risk assessment scale recently developed for Japan-specific social welfare professionals called care managers, to predict pressure injury risk in geriatric individuals who require long-term home care needs.

Methods

A multicenter cross-sectional study was conducted at 30 home-based geriatric support services facilities located at four local districts in Japan. Eligible participants were individuals who needed partial or full assistance for daily living under Japan’s long-term care insurance system (care levels 1–5). The degree of agreement and kappa coefficient were calculated for each item and the total score, after which inter-rater reliability was determined. The effect of the participant’s care level on reliability was also evaluated as secondary analysis.

Results

A total of 96 participants were assessed by 83 care managers (two assessors scored each participant). The degree of agreement and calculated kappa coefficient of the PPRA-Home total score were 59% and 0.72, respectively, with the inter-rater reliability for the total score determined to be “Substantial”. Our subgroup analysis showed that the inter-rater reliability differed according to the participant’s care level. Accordingly, the kappa coefficient for the total score was lower in subgroup “care level 1–3” than in subgroup “care level 4–5” (0.51 and 0.76, respectively).

Conclusion

Our result showed that the PPRA-Home has substantial inter-rater reliability for evaluation of risks of pressure injury development at home care. However, some research focusing on intra-later reliability and validity of the PPRA-Home with adequate sample sizes are required to provide categorical conclusions on whether it can be used for the risk assessment scale in actual clinical settings.