Enxhi Qama , Nicola Diviani , Clara Häfliger , Xavier Jordan , Anke Scheel-Sailer , Claudia Zanini , Sara Rubinelli
{"title":"Approaches to self-management integration and influencing factors in everyday life after spinal cord injury: A qualitative narrative analysis","authors":"Enxhi Qama , Nicola Diviani , Clara Häfliger , Xavier Jordan , Anke Scheel-Sailer , Claudia Zanini , Sara Rubinelli","doi":"10.1016/j.pec.2025.108763","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>This study explores how individuals with spinal cord injury (SCI) integrate self-management (SM) into their everyday lives post-discharge from initial rehabilitation. It focuses on identifying the approaches they employ in balancing health tasks with personal and societal roles and the influencing factors.</div></div><div><h3>Methods</h3><div>We conducted semi-structured interviews with 32 participants, recruited from four rehabilitation centers across Switzerland, three months post-rehabilitation. Data collection spanned from November 2022 to May 2024. We used thematic analysis to identify the challenges and strategies associated with SM integration.</div></div><div><h3>Results</h3><div>Three factors were found to influence SM integration: <em>mind and body dynamics,</em> encompassing physical and emotional aspects; <em>environmental and informational dynamics,</em> including external support, accessible facilities, and availability of information; and <em>society and perception dynamics</em>, including social stigma and misconceptions. These factors shaped the different approaches individuals adopted to integrate SM: <em>The compartmentalizing approach</em>, where individuals focused on one aspect at a time; <em>The mixing approach</em>, where both health and other tasks were prioritized but adjusted; and <em>The embedding approach</em>, where there was equal prioritization with no adjustment on either side.</div></div><div><h3>Conclusions</h3><div>This study contributes to a more nuanced understanding of how to balance both medical and role management in SCI post-discharge. Self-management integration is achieved through different approaches and influenced by a wide range of factors, internal and external ones. Further research should longitudinally explore whether the approach one individual employs changes with the time and what aspects reinforce one or the other.</div></div><div><h3>Practical implications</h3><div>Our findings highlight the need for flexible, personalized SM interventions that are contextually grounded but also adaptive and resilient. Rehabilitation settings should assess different SM integration approaches, using feedback to guide individuals in refining their strategies. Communication guidelines and tailored education sessions are recommended to help align SM practices with patients' evolving goals, including family, social, and leisure priorities.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"136 ","pages":"Article 108763"},"PeriodicalIF":2.9000,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Patient Education and Counseling","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0738399125001302","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
Abstract
Objective
This study explores how individuals with spinal cord injury (SCI) integrate self-management (SM) into their everyday lives post-discharge from initial rehabilitation. It focuses on identifying the approaches they employ in balancing health tasks with personal and societal roles and the influencing factors.
Methods
We conducted semi-structured interviews with 32 participants, recruited from four rehabilitation centers across Switzerland, three months post-rehabilitation. Data collection spanned from November 2022 to May 2024. We used thematic analysis to identify the challenges and strategies associated with SM integration.
Results
Three factors were found to influence SM integration: mind and body dynamics, encompassing physical and emotional aspects; environmental and informational dynamics, including external support, accessible facilities, and availability of information; and society and perception dynamics, including social stigma and misconceptions. These factors shaped the different approaches individuals adopted to integrate SM: The compartmentalizing approach, where individuals focused on one aspect at a time; The mixing approach, where both health and other tasks were prioritized but adjusted; and The embedding approach, where there was equal prioritization with no adjustment on either side.
Conclusions
This study contributes to a more nuanced understanding of how to balance both medical and role management in SCI post-discharge. Self-management integration is achieved through different approaches and influenced by a wide range of factors, internal and external ones. Further research should longitudinally explore whether the approach one individual employs changes with the time and what aspects reinforce one or the other.
Practical implications
Our findings highlight the need for flexible, personalized SM interventions that are contextually grounded but also adaptive and resilient. Rehabilitation settings should assess different SM integration approaches, using feedback to guide individuals in refining their strategies. Communication guidelines and tailored education sessions are recommended to help align SM practices with patients' evolving goals, including family, social, and leisure priorities.
期刊介绍:
Patient Education and Counseling is an interdisciplinary, international journal for patient education and health promotion researchers, managers and clinicians. The journal seeks to explore and elucidate the educational, counseling and communication models in health care. Its aim is to provide a forum for fundamental as well as applied research, and to promote the study of organizational issues involved with the delivery of patient education, counseling, health promotion services and training models in improving communication between providers and patients.