Considerations for a Targeted Self-management Program for Individuals with Traumatic Spinal Cord Injury

Evidence points to the need for increased self-management support efforts to reduce secondary complications in spinal cord injury (SCI). The overall objective of this thesis was to understand the phenomenon of self-management in individuals with traumatic SCI, and then based on this understanding; determine the implementation considerations for a targeted self-management program. This thesis used a mixed methods approach with an exploratory design. . Twenty-six interviews across three stakeholder groups were conducted in Phase I. In the first paper (qualitative), the following five facilitators to self-management were identified: physical support from the caregiver, emotional support from the caregiver, peer support and feedback, importance of positive outlook and acceptance, and maintaining independence. The following five barriers to self-management were identified: caregiver burnout, funding and funding policies, lack of accessibility, physical limitations and secondary complications, and difficulties achieving positive outlook or mood. In the second paper (qualitative), the meaning of self-management among the SCI and caregiver participants related principally to internal responsibility attribution. For the manager participants, the meaning was much narrower and the overarching theme of internal responsibility attribution that was observed among the SCI-caregiver dyads was not as widely expressed by this group. These findings informed the development of a survey that was administered nationally to individuals with traumatic SCI (n=99). In the third paper (quantitative), the components of a tailored self-management program were identified and included the preference for an internet-based program. The final paper examined the association between psychological characteristics in self-management and depression status in individuals with a traumatic SCI. Lower self-efficacy and mastery scores, as well as less time since injury, were associated with depression status. These findings could be used for the development, pilot-testing, and evaluation of a targeted self-management program for individuals with traumatic SCI.Ph.D