Examination of Self-Efficacy and Locus of Control in Protecting Community Integration Following Moderate to Severe Traumatic Brain Injury

This study examines self-efficacy and internal locus of control beliefs as predictors of community integration independent of injury severity for a group of individuals with moderate to severe traumatic brain injury participating in an intensive life skills training program, Radical Rehab Solutions (RRS). Although the long-term affects associated with TBI vary depending on the type and severity of the injury, differences in recovery are seen for persons who appear to have identical injuries (Fuller, 1998). Traditional methods of predicting outcome based on measures of injury severity appear to be the most useful during the first year post-injury. Thereafter, neurological, psychological, and environmental processes appear to interact to influence recovery outcomes. The purpose of the current study is to move beyond the narrow focus of medical restoration approaches to provide further support for a model that conceptualizes cognitive beliefs as predictors of outcome following TBI independent of injury severity. Background: TBI is the leading cause of long-term disability among children and young adults (NIH, 1998). Although advances in acute medical management have enabled people to survive injuries that previously would have been fatal (Khan, Baguley, & Cameron, 2003), these innovations have presented health-care professionals with the challenges of rehabilitating and reintegrating persons with profound, multi-system life changes (Stambrook & Moore, 1995). Preliminary research with TBI populations supports the premise that self-efficacy and locus of control beliefs play an important role in determining outcome following TBI, but has been limited methodologically. Existing studies have exclusively utilized single-measurement designs to establish relationships between cognitive variables and outcomes following TBI, limiting the extent to which researchers can determine whether cognitive variables are related to the dependent measure of outcome over time. Method: A pre-test post-test design was utilized to examine the impact of internal locus of control and self-efficacy beliefs on community integration over time. Participants completed the Multidimensional Health Locus of Control (Form C), the Chronic Disease Self-Efficacy Scales (CDSES), and the Community Integration Questionnaire (CIQ) at baseline and at 90-day follow-up. Data regarding injury severity, change in self-efficacy from pre-test to post-test, and change in internal locus of control from pre-test to post-test were entered into multiple regression analyses in order to determine the influence upon change in community integration from baseline to follow-up. Participants: A sample of 24 participants, ages 22 to 57, were recruited from a holistic, intensive life skills training program (RRS) located in southern West Virginia and eastern Kentucky. Time since injury ranged from 12 months to 444 months, and the length of time unconscious ranged from 1 hour to 195 days. Results: It was hypothesized that change in internal locus of control and self-efficacy beliefs would be more predictive of change in community integration from baseline to follow-up than injury severity. Injury severity was not found to be a significant predictor of change in overall community integration, change in home integration, change in social integration, or change in productivity on the CIQ. Change in internal locus of control was a significant predictor of change in home integration, accounting for 18% of the variance. Change in vocational self-efficacy was found to be a significant predictor of change in productivity, accounting for 34% of the variance. Conclusions: These findings provide partial support for the hypothesis and a model that views cognitive beliefs as predictors of outcome following TBI independent of injury severity. Further research is needed examining the role of self-efficacy and locus of control beliefs in TBI recovery over time that utilizes greater follow-up intervals as well as larger and more culturally diverse samples. In addition, future studies examining neurological and psychological factors underlying control of reinforcement appraisals for individuals following TBI as well as outcome studies of interventions targeting self-efficacy and locus of control beliefs are warranted