A group resilience-promoting programme for individuals whose partners have acquired a spinal cord injury
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Spinal cord injury (SCI) is an acquired physical disability through traumatic injuries such as car accidents and shooting incidents, and non-traumatic injury such as a tumour on the spinal cord, amongst others. Unlike other parts of the body, the spinal cord does not have the ability to repair itself if it is damaged. Consequently, a person who has acquired an SCI will have a physical disability and will be either a paraplegic – paralysis of the lower part of the body, including the legs, or a quadriplegic, which is paralysis of all four limbs. Acquiring a spinal cord injury (SCI) has devastating long-term negative outcomes for the injured person as well as his/her cohabiting partner on a physical, psychological, psychosocial and socio-economical level. Exposure to such prolonged adversity and resulting negative outcomes calls for resilience, namely the ability to positively adapt despite the adversity being exposed to. Not all individuals have the natural ability to “bounce back”, and consequently resilience promotion is imperative. In South Africa, the focus of service delivery in rehabilitation centres is mainly centred on the injured person and consequently the well-being of the spinal cord injured person’s partner (SCIPP) is neglected. Little information is available on resilience-promoting programmes for SCIPPs; thus the main aim of this study was to design and develop a group resilience-promoting programme (GRPP) for SCIPPs. The researcher mainly followed a qualitative research approach and included a small quantitative component. In the context of applied research, an intervention research model comprising six phases was employed. Phase 1, Problem analysis and project planning, was reported on in section A. Manuscript 1 reports on phase 2 (information gathering and synthesis), and consists of a qualitative research synthesis, and mainly aimed at organizing and synthesizing previous research on resilience-promoting processes in order to inform the design and development of a group resilience-promoting programme (GRPP) for SCIPPs. After a systematic review and quality appraisal a total of 74 papers were selected to be quality appraised after abstracts and titles were assessed for relevance. Twenty-one studies were included and synthesized where after an outline for the content of a GRPP for SCIPPs was formulated. Conclusions and recommendations highlight that the formulated GRPP for SCIPPs needs to be further developed into an intervention that could be implemented with SCIPPs. As such, the researcher therefore proceeded with the study (see manuscript 2), aiming in developing small-group programme content and activities (using knowledge gathered from pre-existing interventions; resilience literature; consultations with experts; people living with spinal cord injury (SCI) and personal experience) to promote resilience in SCIPPs. By means of purposive sampling six advisory panel members from a diverse background were interviewed before and after the pilot study with two SCIPPs and one observer to contribute towards the further development of the GRPP for SCIPPs. A six-session GRPP for SCIPPs was formulated, including the following: (1) Information on SCI and resilience; (2) Help SCIPPs understand that their reactions to/emotions regarding these huge changes are normal; (3) Caretaking and support; (4) My dual role; (5) Own caretaking by SCIPPs; and (6) Termination and way forward. The newly developed GRPP for SCIPPs however had to be formally evaluated. Recommendations were made by professionals in the field that the GRPP for SCIPPs should first be subjected to peer review prior to implementing it with the target population. Therefore in manuscript 3 (reporting on phase 5 – evaluation ) the evaluation purpose was to subject the GRPP for SCIPPs to peer review by means of an empirical study with professional role-players (social workers and psychologists) in the field of spinal cord injury, prior to exhibiting it to the target population. The six group sessions were presented to professional role-players (n=12) working within the field of SCI during two 2-day workshops, whereby they were requested to evaluate the content and procedural elements of the GRPP for SCIPPs mainly by means of qualitative research, with a small numerical (quantitative) component. Thematic content analysis and basic descriptive statistics were employed. Overall positive feedback regarding the newly developed intervention was received, with suggested adjustments that needed to be made to the GRPP for SCIPPs prior to formal evaluation with the target group. The GRPP for SCIPPs will further be subjected to expert review in other provinces in South Africa, as the current participants were all from Gauteng. Furthermore, postgraduate students will be recruited to test the programme with the target-population in South Africa for possible further improvement and suggestions, as well as possible expansion to adjust this intervention to meet the needs of male SCIPPs; SCIPs themselves; children of a parent/s living with SCI; and also for post-injury cohabiting relationships, as this intervention might be a starting point for above-mentioned research-opportunities.
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