title: The meaning of self-care in persons with cervical spinal cord injury in Japan: a qualitative study.
abstract: BACKGROUND
  Professionals in Japan tend to regard the individual contexts of persons with spinal cord injury (SCI) as the cause of their passive participation in self-care activities or self-management. However, the meaning of self-care involves variables that interrelate with sociocultural factors. Thus, it is necessary to uncover its meaning in the perceptions of persons with cervical spinal cord injury (CSCI) in order not only to implement better rehabilitation but also to understand the sociocultural constraints that determine the injured person's attitudes to self-care and long-term health outcomes.
  
  
  METHODS
  Semi-structured interviews with 29 CSCI participants from fourteen municipalities of Osaka, Hyogo, and Ehime prefectures were conducted. Participants contributed diverse perspectives on rehabilitation, lay-professional and family relationships, health promotion, and body conceptions. Interviews were recorded, transcribed and analyzed using the grounded theory approach to inter-relate categories and to develop theoretical constructions.
  
  
  RESULTS
  Four main themes emerged from the data: rehabilitation for independence in ADLs; detachment from the body and self; embodiment; and self-management. From the participants' point of view, rehabilitation programs in Japan aim at improving body functions for ADL performance, but provide little health education. These rehabilitation values might hinder some participants from developing self-esteem for their bodies. Moreover, socially-shaped family caregivers' active engagement in the participants' self-care allowed many participants to entirely rely on them for care. Through embodiment, participants found that self-care was not merely a means of independence in ADLs but also of self-management to enhance health and well-being, requiring collaborative relationships with caregivers.
  
  
  CONCLUSIONS
  Personal factors such as low motivation for self-care might be in part a reflection of social expectations of dependence for persons with CSCI. However, the shift in the meaning of self-care from ADLs to self-management implies more active participation in health care needs, shaped through social exchanges. Not only personal factors but also sociocultural factors influence the injured person's valuation of self-care. There is a need for further research to better understand sociocultural influences on illness behaviors among persons with CSCI, so that clinical and community practice can develop accordingly.
authors.forename: Ayako
authors.initials: A
authors.lastname: Ide-Okochi
authors.forename: Etsuko
authors.initials: E
authors.lastname: Tadaka
authors.forename: Kazumi
authors.initials: K
authors.lastname: Fujimura
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D017028:Caregivers; D066193:Cervical Cord / Q000293:injuries*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010465:Perception; D036301:Qualitative Research; D012648:Self Care / Q000379:methods*; D012649:Self Concept; D013119:Spinal Cord Injuries / Q000534:rehabilitation*