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Owuor PM, Miller JD, Kanugula SS, Yeam J, Collins S, Obure V, Arunga T, Otieno P, Olack B, Butler LM, Bukusi EA, Cohen CR, Weiser SD, Young SL. The influence of an agricultural intervention on social capital and water insecurity coping strategies: Qualitative evidence from female smallholder farmers living with HIV in western Kenya. Heliyon 2024; 10:e32058. [PMID: 38873679 PMCID: PMC11170164 DOI: 10.1016/j.heliyon.2024.e32058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024] Open
Abstract
Background Greater social capital is associated with positive health outcomes and better HIV management. The ways by which social capital may influence household water insecurity (HHWI), a critical determinant of health among persons living with HIV, remain underexplored. Further, despite the importance of reliable water access and use for health and agricultural productivity, few studies have described the strategies smallholder farmers living with HIV use to manage water insecurity. Objective We qualitatively explored how an agricultural intervention (provision of a treadle pump for irrigation) influenced HHWI coping strategies through its impacts on social capital among smallholder farmers living with HIV in western Kenya. Method In 2018, we purposively recruited participants from the Shamba Maisha study, a randomized agricultural intervention (NCT02815579) that provided irrigation pumps to improve treatment outcomes and food security among smallholder farmers living with HIV in western Kenya (n = 42). Participants shared their experiences with water insecurity through go-along and photo-elicitation interviews. Data were thematically analyzed using inductively developed codes. Results Participants described diverse strategies for coping with agricultural water insecurity. Dimensions of social capital such as feelings of belonging, connectedness, and trust influenced the use of the treadle water pump and other water access behaviors. For instance, participants reported borrowing or sharing water pumps with friends and neighbors if they felt they had a good rapport. In addition, participants indicated a willingness to engage in collective activities, such as supporting the operation of the irrigation pump during planting, when they felt sufficiently connected to a larger group. Overall, individuals in the intervention arm described greater social cohesion, reciprocity, and community connectedness than those in the control arm. Conclusion The impact of an agricultural intervention on water access and use was described as being modified by social capital among female smallholder farmers living with HIV. Findings suggest that social capital may create an enabling environment for implementing strategies that improve the management and reduce the burden of HIV. Measuring these strategies and their associations with HIV outcomes may strengthen our understanding of resilience among female smallholder farmers living with HIV. The development of a coping strategies index and its use in a longitudinal study could help to identify pathways through which social capital influences health and the effectiveness of livelihood interventions.
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Affiliation(s)
- Patrick M. Owuor
- Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA
- Department of Anthropology, Wayne State University, Detroit, MI, 48201, USA
| | - Joshua D. Miller
- Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Samanvi S. Kanugula
- Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA
| | - Joohee Yeam
- Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA
| | - Shalean Collins
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, 70112, USA
| | - Valeria Obure
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Titus Arunga
- Institute for Policy Research, Northwestern University, Illinois, 60208, USA
| | | | - Beatrice Olack
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Lisa M. Butler
- Department of Public Health Services, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | | | - Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, 94115, USA
| | - Sheri D. Weiser
- Department of Medicine, University of California San Francisco, San Francisco, CA, 94115, USA
| | - Sera L. Young
- Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA
- Institute for Policy Research, Northwestern University, Illinois, 60208, USA
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Cole T, Jamwal R, Hirth MJ. Photovoice to explore the patient experience of a relative motion orthosis following a hand injury. J Hand Ther 2023; 36:433-447. [PMID: 37059599 DOI: 10.1016/j.jht.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/22/2023] [Accepted: 02/01/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Little is known about the patient experience of relative motion (RM) orthoses, or how they impact hand use and participation in occupational roles. PURPOSE To explore the use of Photovoice methodology in hand-injured patients and the patient experience of wearing a RM orthosis. STUDY DESIGN Photovoice methodology, Qualitative Participatory research, feasibility study METHODS: Purposive sampling was used to identify adult patients prescribed a RM orthosis as part of their therapy intervention for an acute hand injury. Over a 2-week period and using their personal camera device participants captured their experience of wearing a RM orthosis and its impact on their daily life. Participants shared 15-20 photos with the researchers. At a face-to-face semi-structured interview, 5 key photographs were selected by the participants with context and meaning explored. Interview data was transcribed, captions and context of images confirmed by member checking, and thematic analysis completed. RESULTS Protocol fidelity was observed using our planned Photovoice methodology. Three participants (aged 22-46 years) shared 42 photos and completed individual interviews. All participants reported their involvement as a positive experience. Six themes were identified: adherence, orthosis factors, expectations and comparisons, impact on daily activities, emotions, and relationships. RM orthoses allowed freedom of movement enabling participation in a range of occupations. Challenges included water-based activities, computer use and kitchen tasks. Participants expectation of orthotic wear and recovery appeared to contribute to their overall experience, with RM orthoses viewed favourably when compared to other orthoses and immobilization methods. CONCLUSIONS Photovoice methodology was a positive process for participant reflection and a larger study is recommended. Wearing a RM orthosis enabled functional hand use as well as providing challenges completing everyday activities. Participants had different demands, experiences, expectations, and emotions associated with wearing a RM orthosis, reinforcing the need for clinicians to take a client-centred approach.
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Affiliation(s)
- Tanya Cole
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia.
| | - Rebecca Jamwal
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia.
| | - Melissa J Hirth
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia.
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Jesus TS, Stern BZ, Struhar J, Deutsch A, Heinemann AW. The use of patient experience feedback in rehabilitation quality improvement and codesign activities: Scoping review of the literature. Clin Rehabil 2022; 37:261-276. [DOI: 10.1177/02692155221126690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To characterize the literature, reported enablers, and gaps on the use of patient experience feedback for person-centered rehabilitation quality improvement and codesign activities. Design Scoping Review. Data sources Scientific databases (PubMed, CINAHL, Rehabdata, Scopus, Web of Science, ProQuest), website searches (e.g. Beryl Institute), snowballing, and key-informant recommendations. Methods Two independent reviewers performed title and abstract screenings and full-text reviews. Eligibility focused on English-language, peer-reviewed (all time) and gray literature (last five years) that used patient experience feedback in rehabilitation improvement activities. The aims, settings, methods, findings, implications, and reported limitations were extracted, followed by content analyses identifying reported enablers and gaps. Results Among the 901 unique references and 52 full texts reviewed, ten were included: four used patient experience surveys for improving patient experiences; six used codesign methodologies to engage patient feedback in service improvement activities. Implementation enablers included securing managerial support, having a structured methodology and facilitator, using efficient processes, engaging staff experiences, and using appreciative inquiry. Reported study gaps included limited follow-up, low sample sizes, analytical limitations, lack of reported limitations, or narrow range of perspectives (e.g. not from people with severe impairments). Conclusion Few examples of the use of patient experience feedback in quality improvement or codesign activities were found in the rehabilitation literature. Patient experience improvement activities relied exclusively on retrospective survey data, which were not combined with often more actionable forms (e.g. qualitative, real time) of patient experience feedback. Further research might consider design of activities that collect and use patient experience feedback for rehabilitation service improvements.
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Affiliation(s)
- TS Jesus
- Center for Education in Health Sciences, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - BZ Stern
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Struhar
- Nerve, Muscle + Bone Innovation Center & Oncology Innovation Center, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - A Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- RTI International, Chicago, IL, USA
| | - AW Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Perspectives of wheelchair users with spinal cord injury on fall circumstances and fall prevention: A mixed methods approach using photovoice. PLoS One 2020; 15:e0238116. [PMID: 32857793 PMCID: PMC7454945 DOI: 10.1371/journal.pone.0238116] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/09/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Wheelchair users with spinal cord injury are at a high risk of falls. However, the perspectives of wheelchair users with spinal cord injury on their fall circumstances and their preferences for fall prevention strategies/interventions remain understudied. Therefore, we aimed to: a) describe the circumstances of falls experienced by wheelchair users with spinal cord injury over a six-month period, b) explore their perspectives of why falls occurred in certain situations, and c) explore their perspectives on recommended content/structure of fall prevention strategies/interventions. Methods This sequential explanatory mixed methods study had two phases. Phase I involved tracking of falls experienced by wheelchair users with spinal cord injury over six months, in which participants completed a survey after experiencing a fall to track the number/circumstance of each fall. Data from the surveys were descriptively reported. Phase II involved a photovoice focus group discussion of the survey findings and their preferences for fall prevention strategies/interventions. Data from the focus group discussion were analyzed using a thematic analysis. Results Thirty-two participants completed phase I. More than half of the participants fell at least once in six months. Falls commonly occurred in the afternoon during a transfer, or when participants were wheeling over uneven ground. One-third of the falls caused an injury. Eleven participants that fell during phase I participated in the focus group. Two main themes were identified from the discussion: 1) “circumstances surrounding the falls” (e.g. when falls occurred, the home is a ‘safe space’) and 2) “suggestions and preferences for fall prevention strategies/interventions” (e.g. fall prevention involves all, fall prevention training available as needed). Conclusion Fall prevention strategies/interventions should be an integral component of rehabilitation practices across the lifespan. Participants recommend customizing fall prevention strategies/interventions to their specific needs to guide the structure, content, and delivery of targeted fall prevention programs.
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Singh H, Scovil CY, Yoshida K, Oosman S, Kaiser A, Craven C, Jaglal S, Musselman KE. Factors that influence the risk of falling after spinal cord injury: a qualitative photo-elicitation study with individuals that use a wheelchair as their primary means of mobility. BMJ Open 2020; 10:e034279. [PMID: 32102820 PMCID: PMC7045099 DOI: 10.1136/bmjopen-2019-034279] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Falls are a concern for wheelchair users with spinal cord injury (SCI). Falls can negatively impact the physical and psychological well-being of fallers. To date, the perspectives of wheelchair users with lived experiences of SCI on the contributors to falls has been understudied. Information about factors that influence fall risk would guide the development of effective fall prevention strategies. OBJECTIVES To gain a comprehensive understanding of the factors that influenced the risk of falling as perceived by wheelchair users with SCI. DESIGN A qualitative study using photo-elicitation interviews. SETTING A Canadian SCI rehabilitation hospital and the participants' home/community environments. PARTICIPANTS Twelve wheelchair users living in the community with chronic SCI. METHODS Participants captured photographs of situations, places or things that they perceived increased and decreased their risk of falling. Semistructured photo-elicitation interviews were conducted to discuss the content of the photographs and explore perceptions of fall risk factors. A hybrid thematic analysis and the Biological, Behavioural, Social, Economic, and Environmental model were used as a framework to organise/synthesise the data. RESULTS Overall, the findings indicated that the risk of falling was individualised, complex and dynamic to each person's life situation. Four main themes were revealed in our analysis: (1) Falls and fall risk caused by multiple interacting factors; (2) Dynamic nature of fall risk; (3) Single factors were targeted to reduce falls and fall-related injuries; and (4) Fall prevention experiences and priorities. CONCLUSIONS Each wheelchair user encountered numerous fall risk factors in their everyday lives. Information from this study can be used to set priorities for fall prevention. Fall prevention initiatives should consider a wheelchair user's fall risks in a holistic manner, acknowledging that a person's current situation, as well as anticipating their fall risks and fall prevention needs, will change over time.
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Affiliation(s)
- Hardeep Singh
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Lyndhurst Centre, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Carol Y Scovil
- Lyndhurst Centre, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Karen Yoshida
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Oosman
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Anita Kaiser
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Lyndhurst Centre, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Canadian Spinal Research Organization, Toronto, Ontario, Canada
| | - Catharine Craven
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Lyndhurst Centre, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Susan Jaglal
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Lyndhurst Centre, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Lyndhurst Centre, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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LaVela SL, Etingen B, Miskevics S, Heinemann AW. What determines low satisfaction with life in individuals with spinal cord injury? J Spinal Cord Med 2019; 42:236-244. [PMID: 29733775 PMCID: PMC6419684 DOI: 10.1080/10790268.2018.1466480] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To examine variables associated with satisfaction with life (SWL) in individuals with a spinal cord injury (SCI). DESIGN Cross-sectional, national survey to assess SWL, demographic and injury characteristics, health care utilization, chronic conditions (obesity, diabetes, heart problems, lung problems, hypertension, high cholesterol), symptoms (poor sleep, pain, depression), social support, grief/loss, and independence. SETTING/PARTICIPANTS Community-dwelling Veterans with SCI. Outcome Measures/Analyses: Bivariate analyses were conducted to assess differences in demographics, injury characteristics, chronic conditions, symptoms, social support, grief/loss, and independence in individuals who reported low SWL (≤20) vs. average/high SWL (21-35). Multivariate logistic regression assessed factors independently associated with low SWL. RESULTS 896 Veterans with SCI (62%) responded. Average age was 62 years, the majority were male (94%), Caucasian (77%), and had paraplegia (61%). Odds of low SWL were 2.4 times greater for individuals experiencing pain (OR = 2.43, CI95: 1.47-4.02, P = 0.0005). Odds of low SWL were increased for individuals reporting greater grief/loss due to their SCI (OR = 1.14, CI95: 1.10-1.18, P < 0.0001). Lesser odds of low SWL were seen for individuals reporting greater emotional social support (OR = 0.97, CI95: 0.96-0.99, P < 0.0001) and independence (OR = 0.94, CI95: 0.90-0.97, P < 0.0001). CONCLUSIONS Pain and feelings of grief/loss due to injury were associated with low SWL. Self-perceived independence and good social support were associated with better SWL. Along with addressing pain and facilitating independence and social support, these findings suggest that interventions to improve SWL should focus on helping individuals deal with grief/loss due to injury.
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Affiliation(s)
- Sherri L. LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA,Correspondence to: Sherri L. LaVela, PhD, MPH, MBA, Department of Veterans Affairs, Edward Hines, Jr. VA Hospital (151-H, Building 1, Office D-312), 5th Avenue & Roosevelt Road, Hines, IL60141, USA; Ph: (708) 202-5895, (708) 202-2499.
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Allen W. Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA,Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Illinois, USA
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Falls, mobility, and physical activity after spinal cord injury: an exploratory study using photo-elicitation interviewing. Spinal Cord Ser Cases 2018; 4:39. [PMID: 29707239 DOI: 10.1038/s41394-018-0072-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 11/08/2022] Open
Abstract
Study design Exploratory qualitative study using photo-elicitation interviews. Objectives To identify contributors to falls, as perceived by individuals with incomplete spinal cord injury, and describe the impact of perceived fall risk on mobility and physical activity. Setting Participants' home and community environments. Methods Eight individuals with chronic motor incomplete spinal cord injury participated. Participants took photographs of situations that increased/decreased their risk of falling, or depicted how this risk impacted mobility and physical activity. Photographs were discussed in semi-structured interviews. Inductive thematic analysis was used to describe participants' perceptions and experiences. Results Photo-elicitation interviews identified four themes: (1) Perceived challenges were primarily environmental with biological (e.g., reduced strength) and behavioral (e.g., risk-taking) factors also identified. (2) Impact of perceived fall risk included moving slowly, avoiding balance-provoking activities, and feelings of frustration and/or fear. (3) Prevent falls: learn through experience included strategies used to avoid falls, which were learnt experientially and consisted of changes to behavior. (4) Factors mitigating impact of perceived fall risk included character traits (i.e., perseverance, optimism) and a desire for independence. Conclusions Primarily environmental factors were perceived to contribute to fall risk and mainly behavioral strategies were adopted to mitigate the risk. Sponsorship Physiotherapy Foundation of Canada.
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Hill JN, Balbale S, Lones K, LaVela SL. Starting a new conversation: Engaging Veterans with spinal cord injury in discussions of what function means to them, the barriers/facilitators they encounter, and the adaptations they use to optimize function. Disabil Health J 2016; 10:114-122. [PMID: 27424945 DOI: 10.1016/j.dhjo.2016.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 05/17/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Assessments of function in persons with spinal cord injury (SCI) often utilize pre-defined constructs and measures without consideration of patient context, including how patients define function and what matters to them. OBJECTIVES/HYPOTHESIS We utilized photovoice to understand how individuals define function, facilitators and barriers to function, and adaptations to support functioning. METHODS Veterans with SCI were provided with cameras and guidelines to take photographs of things that: (1) help with functioning, (2) are barriers to function, and (3) represent adaptations used to support functioning. Interviews to discuss photographs followed and were audio-recorded, transcribed, and analyzed using grounded-thematic coding. Nvivo 8 was used to store and organize data. RESULTS Participants (n = 9) were male (89%), Caucasian (67%), had paraplegia (75%), averaged 64 years of age, and were injured, on average, for 22 years. Function was described in several ways: the concept of 'normalcy,' aspects of daily living, and ability to be independent. Facilitators included: helpful tools, physical therapy/therapists, transportation, and caregivers. Barriers included: wheelchair-related issues and interior/exterior barriers both in the community and in the hospital. Examples of adaptations included: traditional examples like ramps, and also creative examples like the use of rubber bands on a can to help with grip. CONCLUSION(S) Patient-perspectives elicited in-depth information that expanded the common definition of function by highlighting the concept of "normality," facilitators and barriers to function, and adaptations to optimize function. These insights emphasize function within a patient-context, emphasizing a holistic definition of function that can be used to develop personalized, patient-driven care plans.
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Affiliation(s)
- Jennifer N Hill
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center of Innovation for Complex Chronic Health Care (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Edward Hines Jr. VA Hospital, Hines, IL, USA.
| | - Salva Balbale
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Keshonna Lones
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center of Innovation for Complex Chronic Health Care (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Sherri L LaVela
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center of Innovation for Complex Chronic Health Care (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, IL, USA
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