Sustained use of compensatory technology following brain injury: experiences from Neumind users

Assistive technology for cognition (ATC), particularly smartphone-based apps, can significantly enhance rehabilitation outcomes for individuals with acquired brain injury (ABI). Despite demonstrated efficacy, challenges persist in initial uptake and long-term engagement with such technologies. This study employed a mixed-methods approach to examine factors influencing sustained engagement with the Neumind app over 13-14 months among individuals with ABI. Twelve adult participants were interviewed, and their app usage data was quantitatively analysed over nine months post-interview. Eleven participants used the app when interviewed 4-5 months after download (3 highly active, 3 moderately active and 5 occasional users). The six active users maintained their use nine months later. Qualitative thematic analysis identified six major themes impacting sustained ATC engagement: Introduction and Initial Use (recommendation by others, ease of setup), Perceived Benefits (increased confidence, independence), Technical and Functional Challenges (technical issues, reliability, simplicity), User Customisation Preferences (reminder features, calendar scheduling), Community and Social Support (sense of belonging, helping others), and Integration into Rehabilitation and Daily Life (integration with rehabilitation, habit formation, established strategies, timing of introduction). Participants who maintained consistent use reported tangible benefits, effective habit formation, emotional engagement through community participation, and successful integration into rehabilitation routines. Non-users faced technical difficulties, perceived irrelevance of content, and preferred existing strategies. This study underscores the critical role of early introduction, ease of use, community integration, and habit formation in sustaining ATC engagement. Addressing usability barriers, enhancing customisation, and incorporating structured social support may significantly improve long-term use and effectiveness of ATC interventions in neuro-rehabilitation.