Enhancing participation while aging with spinal cord injury: applying behaviour change frameworks to develop intervention recommendations.

STUDY DESIGN: Knowledge translation study. OBJECTIVES: Use the Theoretical Domains Framework (TDF) and Behaviour Change Wheel (BCW) to (1) identify barriers and facilitators to participation in daily activities and social roles among people aging with spinal cord injury (SCI); and, (2) systematically co-develop participation-focused intervention recommendations with SCI community organizations that can support people aging with SCI. SETTING: Canadian SCI community. METHODS: Semi-structured interviews were conducted with 22 people (minimum 45 years of age; minimum 10 years post injury). Participants were asked about their experiences with participating in daily activities and social roles while aging and preferences for what participation-focused interventions should entail. Transcripts were analyzed to address three stages of behaviour change intervention design: (1) identify barriers and facilitators; (2) identify intervention functions and policy categories; (3) identify implementation options. Findings were synthesized into intervention recommendations and assessed for feasibility. RESULTS: Participation in daily activities and social roles was heavily influenced by three TDF domains: environmental context and resources, skills, and social influences. Six intervention functions and all policy categories within the BCW were considered viable intervention options. Multiple messengers and modes of delivery were identified as important. The synthesized recommendations included educating SCI organization membership, partnering with other disability organizations, and advocating to the provincial government. CONCLUSIONS: Findings suggest that multiple intervention formats delivered through a variety of implementation options are needed to enhance participation in daily activities and social roles while aging with SCI. Future efforts should focus on translating the recommendations into real-world behaviour change interventions.

Understanding peer mentorship programs delivered by Canadian SCI community-based organizations: perspectives on mentors and organizational considerations.

STUDY DESIGN: The study used a generic qualitative design. OBJECTIVES: This article set out to garner knowledge of peer mentorship programs delivered by SCI community-based organizations by interviewing people who are directly and in-directly involved with these programs. SETTING: Four provincial community-based SCI organizations across Canada. An integrated knowledge translation approach was applied in which researchers and SCI organization members co-constructed, co-conducted, and co-interpreted the study. METHODS: Thirty-six individuals (N = 36, including peer mentees, mentors, family members of mentees, and organizational staff) from four provincial SCI community-based organizations were interviewed. The participants' perspectives were combined and analyzed using a thematic analysis. RESULTS: Two overarching themes with respective subthemes were identified. Mentorship Mechanics describes the characteristics of mentors and mentees and components of the mentor-mentee relationship (e.g., establish a common ground). Under the theme Peer Mentorship Program Structures, participants described the organizational considerations for peer mentorship programs (e.g., format), and organizational responsibilities (e.g., funding; creating a peer mentorship team). CONCLUSION: This study provides an in-depth look at the characteristics of peer mentorship programs that are delivered by community-based organizations in Canada and highlights the complexity of delivering such programs.

Investigating Characteristics of Quality Peer Mentors With Spinal Cord Injury.

OBJECTIVE: To identify characteristics (1) of high- and low-quality spinal cord injury (SCI) peer mentors; (2) that should be used to match SCI peer mentors and mentees. DESIGN: The study was conducted in partnership with three Canadian provincial SCI organizations using an integrated knowledge translation approach. The Delphi exercise was completed in three rounds. In Round 1, people with SCI completed a thought-listing exercise to identify characteristics of high- and low-quality peer mentors and for matching. In Rounds 2 and 3, people with SCI and community organization staff rated characteristics from the previous round on an 11-point scale. After the final round, the remaining characteristics were thematically analyzed. SETTING: Community-based peer mentorship programs in three Canadian provinces. PARTICIPANTS: People with SCI and SCI community organization staff (Round 1, n=45; Round 2, n=27; Round 3, n=25). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Consensus-based list of characteristics. RESULTS: Participants reached consensus on 215 characteristics of quality peer mentors and 11 characteristics for peer mentor-mentee matching (ICC=0.96). A consensus-based characterization of high- and low-quality peer mentorship was created and included six overarching themes: competencies, personality characteristics, emotional state, mentor outlook, reason for mentoring, and role model. CONCLUSION: A consensus-based characterization of quality peer mentorship was co-developed with input from over 50 members of the SCI community. Findings highlight that peers have both interpersonal and intrapersonal characteristics that contribute to quality mentorship. The findings highlighted the importance of matching mentors on lived experience and shared interests. Findings will inform future research and SCI peer mentorship programs.

Investigating the peer Mentor-Mentee relationship: characterizing peer mentorship conversations between people with spinal cord injury.

PURPOSE: This study aimed to: (1) develop a coding manual to characterize topics discussed and conversation techniques used during peer mentorship conversations between people with spinal cord injury (SCI); (2) assess the reliability of the manual; and (3) apply the manual to characterize conversations. MATERIALS/METHODS: The study was conducted in partnership with three Canadian provincial SCI organizations. Twenty-five phone conversations between SCI peer mentors and mentees were audio-recorded and transcribed verbatim. Ten transcripts were inductively analyzed to develop a coding manual identifying topics and techniques used during the conversations. Inductive technique codes were combined and deductively linked to motivational interviewing and behaviour change techniques. Two coders independently applied the coding manual to all transcripts. Code frequencies were calculated. RESULTS: The coding manual included 14 topics and 31 techniques. The most frequently coded topics were personal information, recreational programs, and chronic health services for mentors and mentees. The most frequently coded techniques were giving personal information, social smoothers, and closed question for mentors; and giving personal information, social smoothers, and sharing perspective for mentees. CONCLUSION: This research provides insights into topics and techniques used during real-world peer mentorship conversations. Findings may be valuable for understanding and improving SCI peer mentorship programs.Implications for RehabilitationSCI peer mentorship conversations address a wide range of rehabilitation topics ranging from acute care to living in the community.Identification of the topics discussed, and techniques used in SCI peer mentorship conversations can help to inform formalized efforts to train and educate acute and community-based rehabilitation professionals.Identifying commonly discussed topics in SCI peer mentorship conversation may help to ensure that peer mentors are equipped with the necessary knowledge and resources, or the development of those resources be prioritized.Developing a method to characterize the topics discussed and techniques used during SCI peer mentorship conversations may aid in designing methods to evaluate how rehabilitation professionals provide support to people with SCI.

Exploring meanings of successful aging among people with long-term spinal cord injury.

Purpose/Objective: The purpose of the present study was to develop an understanding of successful aging (SA) meanings and influences that is informed by the lived experiences of people aging with long-term spinal cord injury (SCI). Method: This study was conducted in partnership with three Canadian provincial SCI organizations using an integrated knowledge translation (IKT) approach. To ensure findings were meaningful and practical to the three SCI organizations, the study was grounded in pragmatic philosophical assumptions. Semistructured interviews were conducted with 22 people aging with long-term SCI (minimum 45 years of age; minimum 10-years postinjury). All interviews were audio-recorded, transcribed verbatim, and subjected to a reflexive thematic analysis. Results: SA was understood as an interconnected and multifaceted concept that prioritizes health, participation, and independence. Participants discussed how SA was influenced negatively by personal (aging-related complications, intrapersonal emotional distress) and environmental (lack of available resources, differing community priorities) barriers. Participants reported that SA was positively influenced when individuals acted as self-advocates, were prepared and aware of aging-related changes, and maintained strong relationships with others. Conclusions/Implications: This study presents an initial, SCI-specific understanding of meanings and influences on SA. Although there were similarities between our findings and previous SA models, pertinent differences were also identified. Findings highlight that supporting quality participation experiences for people aging with long-term SCI may be an important direction SCI organizations can take to support their membership. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Guidance for behavioural interventions aiming to support family support providers of people with spinal cord injury: A scoping review.

RATIONALE: Research has extensively examined the adverse outcomes of being family support provider also known as a family caregiver, of someone with spinal cord injury (SCI) such as psychological distress, poor health, and burden. Despite clear evidence of the negative impact of this social role, few interventions exist aiming to support family support providers of people with SCI. OBJECTIVE: This scoping review aimed to guide future intervention development by identifying the components necessary to develop an intervention to support SCI family support providers using the Behaviour Change Wheel (BCW). METHODS: Electronic databases (CINAHL, PsycINFO, Medline, Embase) were searched in May 2017. Articles relating to outcomes and/or behaviours of support providers of people with SCI were identified. Intervention components of the BCW, including behaviours, factors influencing behaviours, intervention content, and evaluation methods, were extracted from included articles. RESULTS: Of the 59 included articles, most emphasized the outcomes of being a support provider but provided little evidence of behaviours, which may influence such outcomes. The most commonly identified behaviours included engaging in leisure time or daily activities, problem-solving, and providing support. Very few measures were used to measure engagement in behaviours objectively. The literature suggests that behaviours are often influenced by family support providers' physical and social environments. However, barriers may vary between behaviours and contexts. CONCLUSION: The results of this review show that there are many viable behavioural targets for intervention. Therefore, intervention efforts may need to be tailored to individuals' needs. A promising intervention approach may be to use a theory which promotes change in the ecological context of family support providers while encouraging behavioural strategies to overcome individual barriers. Future research should further examine the factors that influence specific behaviours to more comprehensively understand the context of the behaviour as well as effective intervention strategies to promote change.