title: Perceived facilitators and barriers to self-management in individuals with traumatic spinal cord injury: a qualitative descriptive study.
abstract: BACKGROUND
  Current evidence has suggested the need for increased self-management support efforts in spinal cord injury (SCI) to reduce secondary complications. However, current self-management programs may not be suitable for the unique needs of individuals with SCI, including reduced mobility and the importance of attendant care. There is a need for greater understanding of the self-management strategies adopted by individuals with SCI and the potential need for a tailored self-management program. Thus, the purpose of the current study was to understand the perceived facilitators and barriers to self-management to prevent secondary complications.
  
  
  METHODS
  A descriptive qualitative approach was used and involved telephone interviews. Semi-structured interviews were conducted with individuals with traumatic SCI, their family members/caregivers, and managers from acute care/trauma and rehabilitation centres. Participants were recruited between September 2011 and May 2012. Analysis was conducted using inductive thematic analysis to understand the perceived facilitators and barriers to self-management to prevent secondary complications.
  
  
  RESULTS
  A total of 26 interviews were conducted and they included 7 individuals with traumatic SCI, 7 family/caregivers (i.e., 7 SCI-caregiver dyads), and 12 acute care/rehabilitation managers from across the province of Ontario. 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/control over care. 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.
  
  
  CONCLUSIONS
  This study demonstrated that the caregiver and the individual's own mood/outlook, among other facilitators and barriers, make significant contributions to the self-management of individuals with traumatic SCI. The issues of timing/readiness and comorbidities and aging were observed across many of these themes. As such, the development of a tailored self-management program for individuals with traumatic SCI and their caregivers should incorporate these considerations.
authors.affiliation: Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Canada. sarah.munce@mail.utoronto.ca.
authors.forename: Sarah E P
authors.initials: SE
authors.lastname: Munce
authors.forename: Fiona
authors.initials: F
authors.lastname: Webster
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Straus
authors.forename: Eunice
authors.initials: E
authors.lastname: Jang
authors.forename: Susan B
authors.initials: SB
authors.lastname: Jaglal
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D019468:Disease Management; D005260:Female; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010465:Perception / Q000502:physiology; D012648:Self Care / Q000379:methods* / Q000523:psychology; D013119:Spinal Cord Injuries / Q000523:psychology / Q000628:therapy*