A complex systems view of habit and its impact on pressure ulcer risk in adults with spinal cord injury

Background. The lifetime incidence of pressure ulcers among individuals with spinal cord injury (SCI) exceeds 90%; such wounds are contributing factors to the deaths of more than 7% of spinal cord injured individuals. As many of the known risk factors for pressure ulcer development are arguably habit-based, a deeper understanding of the nature of habit and its role in pressure ulcer development could have significant implications for rehabilitation practice. Complex systems theory provides an ideal language for developing a conceptual framework for understanding habit, as complex systems theory and the notion of habit as understood in a broad sense are both concerned with understanding the emergence of regular, patterned activity.;Purpose. To explore how habits impact the development of pressure ulcers in people with spinal cord injury. Methods: The study will involve an in-depth case study based on secondary analysis of interview data collected during an ethnographic study of community dwelling adults with spinal cord injury. Data were coded for the presence of habits; relationships, influences and interactions among these habits; areas of stability and chaos; and events impacting on levels of stability and chaos.;Results. The participants' daily lives included a number of habits that contributed both directly and indirectly to the development of medically significant pressure ulcers.;Conclusions. Current rehabilitation practices frequently follow an educational model premised on the belief that increasing a patient's knowledge and enhancing motivation will result in behavior change. Recent research into the role of habit in shaping human behavior challenges this assumption. Based on the findings of this study, pressure ulcer prevention programs should be re-conceptualized as attempts to alter habits.;Supported By. The ethnographic study on which this research was based was supported by NIDRR (grant no. H133G000062). The Division of Occupational Science and Occupational Therapy at the University of Southern California provided support in the form of graduate student assistantships for this dissertation.