title: Meaning of self-management from the perspective of individuals with traumatic spinal cord injury, their caregivers, and acute care and rehabilitation managers: an opportunity for improved care delivery.
abstract: BACKGROUND
  The trend of decreasing length of stay in rehabilitation facilities has led to individuals with spinal cord injury (SCI) entering the community with unmet needs and fewer self-care skills to prevent secondary complications. The implementation of a self-management program for individuals with SCI for the management of these complex needs, including secondary complications, may be one option to fill these care gaps. A greater understanding of the meaning of self-management may facilitate the development of a tailored self-management program in this population. Thus, the current research aims to understand the meaning of self-management in traumatic SCI from the perspectives of individuals with traumatic SCI and their caregivers as well as acute care/trauma and rehabilitation managers.
  
  
  METHODS
  A descriptive qualitative approach was used. Semi-structured telephone interviews were conducted with 26 individuals with traumatic SCI, their family members/caregivers, and managers from acute care/trauma and rehabilitation centres. Inductive thematic analysis was applied.
  
  
  RESULTS
  The meaning of self-management in SCI related to two overarching themes of internal and external responsibility attribution and revealed differences between the meaning of self-management in SCI among individuals with traumatic SCI and their caregivers versus managers. Overall, the meaning of self-management among the SCI and caregiver participants related principally to internal responsibility attribution. For the manager participants, the meaning of self-management 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.
  
  
  CONCLUSIONS
  Interventions that are co-created by users and health care professionals are associated with positive physical and mental health outcomes. Thus, the understanding of self-management from these varying perspectives could be applied to the development of a tailored self-management program that is relevant to individuals with traumatic SCI and their caregivers. This may involve the development of a program that uses some of the structure of traditional chronic disease self-management programs, in accordance with the beliefs held by the managers, but also incorporates elements of wellness/health promotion interventions, in accordance with the beliefs held by the SCI and caregiver participants.
authors.affiliation: Institute of Health, Policy, Management and Evaluation, University of Toronto, Rehabilitation Sciences Building, 160-500 University Ave., Toronto, M5G 1 V7, ON, Canada. sarah.munce@mail.utoronto.ca.
authors.forename: Sarah E P
authors.initials: SEP
authors.lastname: Munce
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
authors.forename: Fiona
authors.initials: F
authors.lastname: Webster
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.affiliation: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Straus
authors.affiliation: Department of Applied Psychology & Human Development, Ontario Institute for Studies in Education, Toronto, Ontario, Canada.
authors.forename: Eunice
authors.initials: E
authors.lastname: Jang
authors.affiliation: Institute of Health, Policy, Management and Evaluation, University of Toronto, Rehabilitation Sciences Building, 160-500 University Ave., Toronto, M5G 1 V7, ON, Canada.|Department of Physical Therapy, University of Toronto, Toronto, Canada.|Toronto Rehabilitation Institute, Toronto, Canada.
authors.forename: Susan B
authors.initials: SB
authors.lastname: Jaglal
mesh_terms: D000328:Adult; D001294:Attitude to Health; D017028:Caregivers; D006233:Persons with Disabilities; D019468:Disease Management; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care; D013119:Spinal Cord Injuries / Q000628:therapy*