Abstract
Background: Traumatic spinal cord injury (TSCI) profoundly impacts individuals, hindering their return to previous roles. Community reintegration (CR) is crucial and requires holistic engagement. Stakeholders’ perspectives shape outcomes and are vital in regions like South Africa with limited rehabilitation infrastructure. Understanding their viewpoints is crucial.
Aim: To explore multiple stakeholders’ perspectives on factors influencing CR after TSCI in South Africa.
Setting: The research was conducted in the Cape Metropolitan Area, within South Africa’s Western Cape province, home to around 3.7 million residents.
Methods: A qualitative exploratory descriptive design was used. Semi-structured face-to-face interviews were conducted and audio-recorded. The recordings were transcribed verbatim, accuracy-checked, and uploaded to Atlas.ti.® 23 software for data coding and analysis. Thematic analysis was utilised.
Results: Six main themes and fifteen categories were identified within the international classification of functioning disability and health (ICF) framework’s contextual factors domain, highlighting the impact of environmental and personal factors on CR. Stakeholders emphasised the need for accessible environments, technology, support networks, attitudinal changes, improved services and personal resilience to facilitate CR.
Conclusion: Our findings emphasise the need for investments in accessibility, inclusivity, assistive technologies, awareness campaigns and policy reforms to support successful reintegration and foster resilient communities for individuals with TSCI.
Contribution: This study illuminates key factors influencing CR and underscores the importance of comprehensive interventions, contributing to the understanding of the multifaceted challenges of CR after TSCI in South Africa.
Keywords: community reintegration; integration; South Africa; stakeholders; traumatic spinal cord injury.
Introduction
Traumatic spinal cord injury (TSCI) leads to profound physical, emotional and social changes that significantly hinder one’s capacity to reclaim previous roles and activities (Rivers et al. 2018). Community reintegration (CR), viewed as the ultimate goal of rehabilitation, involves engaging in physical and social environments (Rauch et al. 2010; Sinnott et al. 2010). Dijkers (1999) defines CR as resuming roles, statuses and activities aligned with one’s demographics within relationships in community settings. This aligns with the international classification of functioning disability and health (ICF)’s view of participation, emphasising personal and environmental factors enabling or hindering community engagement for those with disabilities (Scelza et al. 2007).
While often used interchangeably, CR and participation differ. Community reintegration involves holistic inclusion, acceptance, access and relationships. It aims for full functioning across life roles rather than just involvement in some activities. On the other hand, participation refers more narrowly to partaking in select community activities without achieving independence in major roles (Van de Velde et al. 2010). Although interconnected and crucial for inclusion, CR and participation are shaped by multidimensional factors where individuals exist (Joseph et al. 2016). Thus, a comprehensive evaluation of factors influencing CR post-injury is key for service design.
Prior researchers have explored factors enabling or hindering CR following TSCI including age, injury level, cause and ethnicity (Kashif et al. 2019). Coping strategies and satisfaction also significantly impact the process (Hansen et al. 1998). Broader social and environmental factors like family support, housing, information, transportation, accessibility, community attitudes, policies and economics also play pivotal roles in CR and adjustment post-injury (Magasi et al. 2009).
Multiple stakeholders have vested interests in CR outcomes flowing TSCI. These include persons with TSCI, families, caregivers, rehabilitation professionals and disability advocates (Magasi et al. 2009). Their differing roles shape distinct perspectives on the meaning and measurement of successful CR. Individuals with TSCI emphasise accessible environments, transportation and technology for rehabilitation and CR (Gargaro, Warren & Boschen 2013). Family and caregivers provide emotional support, assist with tasks and advocate needs and rights of persons with TSCI (Hammell 2004). Rehabilitation professionals deliver care for physical, psychological and social aspects, guiding functional independence and adaptive strategies (Trezzini & Phillips 2014). Advocates raise awareness, fight discrimination and promote inclusion (Moreno et al. 2017). By considering all viewpoints and roles of these different stakeholders, a more complete picture emerges for defining and optimising successful CR outcomes (Magasi et al. 2009). Thus, collaboration among these stakeholders ensures a whole-of-society reintegration approach.
Understanding the complexity of CR post-TSCI is crucial in countries like South Africa, where the prevalence is high yet the infrastructure for rehabilitation is limited. Previous research identified key aspects of the journey after TSCI, including ‘dealing with the new self’, ‘a journey dominated by challenges’, ‘peer mentoring as a catalyst’ and ‘becoming an agent of change for self and others’ (Joseph et al. 2016). However, there’s a gap in understanding these factors from diverse stakeholder perspectives. Gathering insights from individuals with TSCI, families, caregivers, healthcare professionals and community members can offer a comprehensive view of the challenges faced and inform targeted interventions and policies. Thus, this study aimed to explore multiple stakeholders’ perspectives on factors influencing CR after TSCI in South Africa.
Research methods and design
Design
The study utilised a qualitative exploratory descriptive design to delve into the perspectives of stakeholders regarding factors influencing CR after TSCI in South Africa. This approach enabled individuals with TSCI to articulate their experiences within communities, while allowing other stakeholders to express their insights on the requirements for successful CR post-TSCI (Bradshaw, Atkinson & Doody 2017).
Setting
The research was conducted in the Cape Town Metropolitan Area, situated within South Africa’s Western Cape province, a region that is home to approximately 3.7 million residents. Selected for its rich ethnic diversity, the Cape Metropole encompasses a population comprising individuals of black African, white and mixed-race backgrounds. Spanning across expansive urban and peri-urban landscapes, its catchment area is one of the largest in the nation. The diverse demographic composition and expansive geographic reach of the Cape Town Metropolitan Area make it an ideal setting for conducting research that aims to capture the nuances and complexities of a multicultural society.
Recruitment strategy
Selecting participants to understand the research problem in qualitative research is crucial (Creswell 2003). Purposive sampling was used for all stakeholder categories. Individuals with TSCI were recruited through convenience sampling, utilising existing spinal cord injury networks, groups and organisations. Caregivers were recruited from those of individuals with TSCI involved in the study. Other stakeholder groups were purposively selected from their organisations based on their roles and involvement in rehabilitation and CR.
Population and sampling
Participants were purposefully selected to provide diverse perspectives on CR following TSCI in South Africa. Key stakeholder groups included individuals with TSCI (n = 11), caregivers (n = 5), members representing disabled people’s organisations such as non-profit organisations and nursing and/or old age homes (n = 5), rehabilitation professionals (n = 3), members of the Quad-Para Association of South Africa, a non-profit organisation providing training, support and housing for individuals who have sustained SCI in South Africa (n = 2), and representatives from transportation services (n = 2). Geographical diversity was ensured by recruiting from both urban and semi-urban areas. Overrepresentation of individuals with TSCI (n = 11) was intentional to capture a comprehensive range of perspectives (Magasi et al. 2009). Each group contributed distinct insights, enhancing our understanding of the challenges, barriers and facilitators associated with CR after TSCI in South Africa.
Data collection instrument
The lead author (E.N.) developed an interview guide to capture insights on multiple stakeholders’ perspectives regarding factors influencing CR post-TSCI. Open-ended questions were developed to facilitate comprehensive responses, allowing participants to freely express their views on CR factors. To ensure study credibility, co-author (J.P.) reviewed the guide for clarity and relevance, to eliminate ambiguities. Additionally, the guide underwent pilot testing with two TSCI participants and one representative from each other stakeholder group to refine and validate its effectiveness. The pilot study assessed question appropriateness and provided preliminary insights into research feasibility (Braun & Clarke 2006). Table 1 presents sample main interview guide questions for both individuals with TSCI and other stakeholders.
| TABLE 1: Example of main questions asked to different stakeholders to explore their perspectives on the factors influencing community reintegration. |
Data collection procedures
Following ethical approval, potential participants received email invitations from the lead author (E.N.) inviting voluntary participation. Accompanying the invitations were information sheets detailing the study’s purpose and ethical considerations, along with consent forms for participants to sign and return prior to engagement.
Semi-structured face-to-face interviews, conducted by E.N., occurred at venues chosen by participants and were audio-recorded. No external observers were present. E.N. followed a prepared interview guide while allowing flexibility to delve deeper into responses, ensuring alignment with study objectives. Probing questions elicited detailed participant insights, while efforts were made to prevent the interviewer’s perspectives from influencing responses. Co-constitution techniques, like paraphrasing, were employed to clarify intended meanings (Bradshaw et al. 2017). Interviews typically lasted between 30 min and 45 min.
Data analysis
Thematic analysis was used to examine interview data, offering insight into diverse participant perspectives (Guest, Namey & Chen 2020). Analysis involved transcription of recordings, cross-referenced with notes to ensure accuracy. Through deductive coding guided by the ICF framework, the themes and categories related to the environmental factors influencing CR were identified. Since ICF has not clearly included personal factors within the framework, the themes and categories related to personal factors influencing CR were inductively generated. Broader categories were then created by repeatedly revisiting the data. Robustness of analysis was assessed using Braun & Clarke’s (2006) 15-item checklist.
Transcription and data coding
Following Braun and Clarke’s six phases of thematic analysis (Braun & Clarke 2019), E.N. engaged in data familiarisation through repeated reading and note-taking. Initial codes were generated, followed by searching and reviewing themes, defining and naming them, and finally generating reports. E.N. developed a preliminary codebook using four transcripts and consulted experienced co-authors (J.P., C.J. and Q.A.L.) to enhance reliability and rigour, generating additional codes as needed. All authors compared and discussed codes, merging them into a final codebook for analysing remaining transcripts. ATLAS.ti.® 23 software facilitated data coding and analysis.
Trustworthiness of qualitative data
To ensure credibility, interview transcripts were shared with four participants for feedback on accuracy (Creswell & Miller 2000). Transferability was addressed by thoroughly describing methods for data collection, analysis and interpretation. This process provides a comprehensive understanding of a study, allowing other researchers to assess the relevance and applicability of findings to their contexts. Dependability was established by providing comprehensive details on research design, implementation, data collection details and reflective examination of transcripts (Nowell et al. 2017). Confirmability was attained through an audit trail involving comprehensive records and a clear account of data collection and analysis procedures (Boschen, Tonack & Gargaro 2003).
Ethical considerations
Ethical approval to conduct this study was obtained from the Senate Research Committee of the University of the Western Cape (No. 15/4/51).
Results
The characteristics of the persons with TSCI are presented in Table 2, and those of other stakeholders are presented in Table 3 using pseudonyms to protect the participants’ identities.
| TABLE 2: Characteristics of individuals with a traumatic spinal cord injury (n = 11). |
| TABLE 3: Characteristics of other stakeholders (n = 17). |
The analysis of data from all stakeholders identified 6 main themes and 15 categories within the ICF framework’s contextual factors domain. Individuals with TSCI shared personal experiences, noting obstacles and facilitators in CR. Other stakeholders echoed these experiences and provided perspectives on critical factors for optimal CR. Figure 1 outlines the emerged themes and categories from the analysis.
 |
FIGURE 1: Themes and categories identified by multiple stakeholders. |
|
All identified themes fall within the ICF contextual factors and highlight the impact of both environmental and personal factors on CR following a TSCI.
Theme 1: Natural and human-made changes to the environment
The natural environment and human-made changes significantly impact the reintegration of individuals with TSCI into their communities. Limited home accessibility and space pose major barriers to independence, with cramped quarters hindering wheelchair manoeuvrability and basic functioning. Some adapt resiliently, while others seek more suitable living arrangements:
‘When I returned home, the lack of space made it challenging to move around with a wheelchair.’ (Tom, Male, Paraplegia)
‘After the accident, my house not suitable and I decided to come here [nursing home] where I have enough space.’ (Peter, Male, Quadriplegia)
Individuals with TSCI also face outdoor barriers because of inaccessible infrastructure and lack of inclusive facilities, leading to social isolation and confinement:
‘The side roads is not suitable and I struggle to move around that is why I often prefer not to go out.’ (James, Male, Paraplegia)
‘I used to play basketball but now I am confined to a wheelchair due absence of recreational facilities. There should be adapted sports and recreation facilities for people with disabilities.’ (Paul, Male, Quadriplegia)
Other stakeholders, including representatives from organisations for disabled people and healthcare professionals, emphasised the importance of adapting both private residences and public areas to meet the wheelchair accessibility requirements of individuals with TSCI. They also emphasised the importance of accessible infrastructure and amenities to foster full reintegration and equality:
‘For me, full reintegration means modifying toilets, bathrooms, and kitchens to fit the needs of persons with TSCI and ensure full participation.’ (PRDPO1, Male, Person representing disabled people’s organisation)
‘Public toilet seats are often too low or inaccessible. ATMs are too high and difficult to access. Banks should have dedicated help desks.’ (RP3, Female, Rehabilitation professional)
Theme 2: Products and technology
Improving accessibility and facility adaptations is crucial for equitable community navigation and recreation opportunities for wheelchair users. However, individuals with TSCI face challenges with inaccessible public transport and discriminatory attitudes from taxi drivers, exacerbating mobility issues and hindering employment, learning activities and medical appointments. Moreover, designated parking spaces for people with disabilities are often occupied by able-bodied individuals, compounding the problem:
‘Taxi drivers often refuse to carry us or charge extra money because we are in wheelchair.’ (Tim, Male, Paraplegia)
‘I got a job but could not take it because I need hired vehicle as I cannot get there with a wheelchair.’ (Ana, Female, Paraplegia)
‘The other problem is that, in many places you find that there are not parking designated for persons with disabilities. Even those that are available sometime you find that they have been taken by able bodied people.’ (John, Male, Paraplegia)
The lack of consideration for these needs leads to social exclusion and dependency. Improved accessibility and facility adaptations are essential for wheelchair users to navigate communities and access recreation opportunities equitably.
Individuals with TSCI also underscored the significance of technology in facilitating CR, particularly highlighting how motorised electric wheelchairs enable those with quadriplegia to navigate their surroundings effectively:
‘My arms are very week and could not use a normal manual wheelchair. But now, thanks to technology that with this electric wheelchair, I am able to move around.’ (Nick, Male, Quadriplegia)
Rehabilitation professionals and disability advocates stressed accessible transport’s crucial role in successful CR, proposing inclusive transportation policies and expanding services like Dial-a-Ride to wider areas. They also emphasised the importance of assistive technologies in overcoming physical barriers to reintegration:
‘I know that there is a company called dial a ride that provides special transport for people with disabilities but getting into that system is still a big challenge. In addition, these services are not operational in the whole South Africa only in few major cities.’ (PRDPO4, Male, Person representing disabled people’s organisation)
‘But let’s think about technology where people can do things online, let’s have assistive technology so that they can do things on computers and do the things and teach themselves. So there are many options out there.’ (RP1, Male, Rehabilitation professional)
Overall, stakeholders highlighted that overcoming barriers to transportation and leveraging assistive technology can enhance mobility, independence and opportunities for individuals with a TSCI to actively participate in various aspects of community life including employment.
Theme 3: Support and relationships
Support systems and relationships are essential for well-being, offering the support needed to navigate life’s challenges. Many individuals with TSCI expressed gratitude for family support, yet some felt burdensome, straining relationships and leading to move to nursing homes:
‘If I want to go to the clinic my brother always pushes me there … and if my brother is not available my sister in-law pushes me.’ (Monica, Female, Quadriplegia)
‘When I got home from the hospital I was staying with my mother … but at later stage our relationship became so tense and then I decided to come and live here [Nursing home] and now our relationship is back to normal.’ (Peter, Male, Quadriplegia)
Some rehabilitation professionals and caregivers also stressed the vital role of family and friends’ support in reintegrating individuals with TSCI into their communities. They highlighted the ongoing need for such support but also acknowledged the challenges faced by caregivers in balancing their own lives while providing care:
‘Support from family members and close friends is important and it can play a valuable role in facilitating individuals with SCIs to reintegrate back into communities.’ (RP2, Female, Rehabilitation professional)
‘I think family members and friends should always be there to give support to injured person when needed … However, they must also be given a kind of incentive just to encourage them. As you know, when you are taking care of a person with disability you intend to lose your own friends and your own leisure time.’ (CG5, Female, Caregiver)
Overall, the collective efforts of family members, caregivers, rehabilitation professionals and communities are instrumental in empowering individuals with TSCI to fully reintegrate into their communities, lead fulfilling lives and overcome the obstacles posed by their condition.
Theme 4: Attitude
Attitudes towards people with disabilities are pivotal in shaping their social interactions, opportunities, CR and overall well-being. Positive attitudes foster inclusion and equality, while negative attitudes can lead to exclusion and discrimination. Individuals with TSCI emphasised educating the wider community to prevent discrimination. They stress raising awareness, promoting acceptance and dispelling misconceptions through public education:
‘Their attitudes make me sick … They need to be educated; they need to know that we are human beings like them.’ (Nick, Male, Quadriplegia)
Overall, participants expressed a need to counter discrimination and promote acceptance of disability diversity through greater public awareness and education, in order to support the reintegration and inclusion of individuals with TSCI in their communities.
Theme 5: Services, systems and policies
Social support, employment policies and skills training are crucial for facilitating community involvement and reintegration for individuals with TSCI. These individuals encounter significant barriers to employment post-injury, struggling to return to previous roles and find accommodating opportunities:
‘Before I got this accident, I was working with this company as a driver, after my rehabilitation I could not go back to work because I was in the wheelchair. I called them to find out if they could give an alternative job. They said that they will call me back, but I never heard from them again.’ (John, Male, Paraplegia)
Discrimination in terms of employment based on race and physical disabilities was highlighted by both people with a TSCI and other stakeholders:
‘I think government is discriminating us due to our race. Because I am a white person I cannot get a job. Most of the job adverts say “only black people must apply”. I also need to get ahead in my life but I cannot even send my CV because most of job adverts clearly states that only blacks must apply.’ (Nick, Male, Quadriplegia)
‘The employers do not want to employ people with disabilities. Especially people with physical disabilities because they do not want to adjust the work environment in order to meet the needs of disabled people. So I think they should not be any discrimination towards employment opportunities based on any condition including people with disabilities.’ (RP3, Female, Rehabilitation professional)
Stakeholders were of opinion that skills training programmes could be implemented that would assist young individuals who sustained a TSCI to venture into an alternative career path. They emphasised the need for tailored skills training in alternative fields like office work or computing, to empower pursuing new careers better aligned with their abilities:
‘The only way to create the job opportunities for individuals with spinal cord injuries is to introduce them to some companies that are willing to mentor them and train them in different skills that can meet their conditions. For example, they can train them in phone operators, call centres or even computer skills.’ (PRDPO3, Female, Person representing disabled people’s organization)
‘I think there should be programs like call centres programs or any other programs that can be able to train the individuals with disabilities in skills that can facilitate them to get like office jobs or something like that.’ (CG2, Female, Caregiver)
Overall, the lack of social support systems, discriminatory employment practices and inadequate skills training programmes pose significant challenges to the reintegration of individuals with TSCI into their communities.
Theme 6: Personal factors and believes
Personal factors and beliefs shape how individuals perceive the world and interact with others, significantly impacting their overall well-being and life choices. Personal beliefs significantly influenced CR for individuals with TSCI. Their experiences underscored various psychological and emotional factors, wherein many showcased self-efficacy, believing in their ability to overcome challenges through skill development:
‘There are many places which are not comfortable, but you can make it comfortable for you. You can make life easier even if it seems very difficult. If you choose to be negative, then everything will be difficult for you.’ (Tim, Male, Paraplegia)
Faith and resilience were pivotal for many individuals with TSCI. Belief in a divine purpose behind their situation motivated them to confront obstacles, fostering hope and a positive attitude towards life’s second chances. Broadly, faith provides strength and emotional support, bolstering confidence to tackle societal misconceptions about disability:
‘I know that there are many things against me, many battles to fight but I know with God all is possible if I do it the way he wants me to do, I can overcome anything.’ (Tim, Male, Paraplegia)
However, TSCI often reduces confidence and a sense of belonging. Increased self-consciousness about their disability and concerns about judgement or success can lead to diminished self-assurance and social skills. Isolation occurs as they lose touch with social circles, struggling to adapt to their changed reality post-injury. Insecurities about their disability also lead to fears around relationships:
‘I used to do part time event planning before the accident. But because my job requires me to speak in front of big crowds, I noticed that after the accident I do not have the same ability and confidence to walk up to people and speak over the mic again.’ (Mary, Female, Paraplegia)
‘I used to have a girlfriend before, but she left me immediately after the accident. Now I do not have one and I am scared to approach any girl when I am still in this wheelchair … What about if I approach someone and she rejects me because I am in the wheelchair? I am really scared my brother.’ (Tom, Male, Paraplegia)
Overall, while TSCI was found to generate psychological struggles for many, personal strengths like self-efficacy, faith and resilience allowed moving forward with determination.
Discussion
The ultimate goal of TSCI rehabilitation is to optimise CR and fulfil social roles. However, the interplay between health conditions, body functions, activity participation and environmental factors significantly influences CR for individuals with TSCI. This dynamic, reflected in the ICF model, underscores how personal and environmental factors facilitate or hinder CR. The study highlights the complex interplay of environmental, social and personal factors impacting CR, emphasising the need for accessible environments, inclusive policies, public awareness and personal empowerment to facilitate full participation and inclusion of individuals with TSCI.
In this study, individuals with TSCI described challenges with CR because of inaccessible residences, buildings, roads and facilities, reflecting barriers in the ICF domain of ‘Natural environment and human-made changes’. These barriers are echoed by rehabilitation professionals and disabled people’s organisations, emphasising the importance of home and outdoor modifications for successful CR post-TSCI. The findings of this study are consistent with previous literature (Barclay et al. 2016; Nunnerley, Hay-Smith & Dean 2013; Pershouse et al. 2012; Price et al. 2011, Stiens et al. 2002) which reported inadequate environments as barriers to residential and CR after TSCI. Dijkers (1999) stated that full participation in family and community life is crucial for social reintegration. Ahmed et al. (2018) noted that independent living is difficult as most individuals with TSCI lack access to disability-friendly housing and communities.
This study highlights the unique housing challenges for South Africans with TSCI who live in informal dwellings or shacks and despite their constitutional rights, often lack access to suitable, wheelchair-accessible homes (Hatchard 1994). As dwellings frequently lack accessibility, individuals with TSCIs might be forced into nursing homes, violating disability rights that emphasise residence choice. Collaborative governmental, private and non-profit efforts are needed to increase accessible housing availability and modify environments to create disability-friendly community spaces.
On closer look to the ICF domains of ‘product and technology’, inaccessible transport was a major obstacle for individuals with TSCI to fully participate and reintegrate in community life aligning with previous reports (Lysack et al. 2007). Caregivers suggested developing inclusive policies and expanding services like Dial-a-Ride to minimise these transportation problems. Although modified cars facilitated community access for some, unavailable disabled parking and misuse by able-bodied individuals posed problems. This confirms previous findings (Carpenter et al. 2007) which reported that appropriate public transport, driving one’s own car, and access to disabled parking are important facilitators to CR. Thus, a multi-sectoral approach addressing barriers such as providing accessible transport and disabled parking, and educating the public on proper use, is paramount to enhance community engagement and quality of life for TSCI individuals in South Africa.
Further to the ICF domain of ‘services, systems, and policies’, individuals with TSCI reported that the lack of post-injury employment policies and inaccessible transport were interrelated barriers to CR. This finding aligns with prior research by Lidal et al. (2007), which highlighted how transportation issues, discrimination, and lack of skills training collectively limit work opportunities for individuals post-TSCI. There seems to be a ‘catch-22’ situation where inaccessible transport prevents work access but securing employment is also impossible if transport remains inaccessible. A multisectoral approach is needed, with government and stakeholders coordinating interventions enabling disability-friendly transport, workplace accommodations, improved employer attitudes and skills training to aid disabled individuals re-enter the job markets and integrate into communities.
When examining ICF domains ‘Support, Relationships, and Attitudes’, this study findings provide evidence that supportive relationships with family and friends are crucial facilitators of community reintegration (CR) for individuals with TSCI. On the other hand, negative attitudes and a lack of support from families, friends and the general public were identified as significant barriers to CR for individuals with TSCI. These findings align with previous research by Carpenter et al. (2007), Barclay et al. (2016), and Ripat et al. (2012), which reported that social support from friends, families and peer mentors was found to assist social participation and CR, while the findings by Lysack et al. (2007) highlighted negative attitudes as a primary obstacle to CR following SCI. Thus, nurturing supportive relationships through empathy, respect, positive interactions and providing access to peer support networks is vital for the successful reintegration of individuals with TSCI.
Contrary to previous reports (Middleton et al. 2007), individuals with TSCI demonstrated positive self-efficacy to overcome challenges and achieve goals like further education and better jobs. However, some struggled with a lack of confidence, a sense of not belonging, fears of returning to work or social activities, and doubts about intimacy, aligning with research on perceived loss of gender roles post-injury (Burkhart, Kale & LaVela 2021; Federici et al. 2019). Understanding these personal factors is essential to develop patient-centred interventions supporting TSCI reintegration.
Strength of the study
- The study included perspectives from individuals with TSCI, rehabilitation professionals, caregivers and representatives of disability associations. This diversity of viewpoints enriches the analysis and provides a well-rounded understanding of the issues at hand.
- The study covered various aspects of the reintegration process, including environmental, technological, social, attitudinal and personal factors. This comprehensive approach allows for a more nuanced understanding of the challenges and opportunities faced by individuals with TSCI.
Limitations
- Although this study included multiple rehabilitation stakeholders, some of them were under represented. Therefore, their views may be limited.
- The study involved only participants of one province (the Western Cape province). Therefore, their perspectives cannot be generalised to be representative of all rehabilitation stakeholders in South Africa.
Conclusion
This study underscores the complexity of CR after TSCI in South Africa. By examining diverse stakeholders’ perspectives, we gained insights into factors influencing CR. Individuals with TSCI shared personal experiences illuminating how these factors enable or hinder successful reintegration. Stakeholders provided additional perspectives on critical elements for optimal CR. The findings highlight the need for comprehensive interventions addressing physical, social, attitudinal and policy challenges. Furthermore, the study found that emphasising accessibility, inclusivity and supportive communities is vital. Investing in affordable assistive technologies, awareness campaigns and policy reforms can help create a society where those with TSCI can reintegrate successfully. The results encourage social connections and relationships, recognising the importance of personal resilience in facilitating reintegration.
Acknowledgements
Competing interests
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
Authors’ contributions
E.N. managed the entire project and was responsible for conceptualising the study, collecting and analysing the data, writing the first draft, and the final version of the article. J.P. assisted in conceptualisation, assisted in data analysis, procured the funding and approved the final version of the article. Q.A.L. assisted in data analysis, contributed to the first draft and approved the final version of the article. C.J. assisted in data analysis, contributed to the first draft and approved the final vision of the article.
Funding information
This project was funded by the National Research Foundation of South Africa (NRF) (Award no 98727).
Data availability
The data of this manuscript are available from the corresponding author, E.N., upon the reasonable request.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. They do not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The authors are responsible for this article’s results, findings and content.
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