Perceived threat of and communication about subsequent injury among individuals with spinal cord injury

Subsequent injuries are a threat to morbidity and mortality following spinal cord injury (SCI), however little is known about the experience and perceptions of subsequent injury among individuals with SCI. The aim of this study was to explore subsequent injury experiences among individuals with SCI, along with their perceived threat and perceived efficacy, and health locus of control in preventing subsequent injury. Semi-structured, in-person interviews were conducted with 14 individuals with SCI. Guided by the Extended Parallel Process Model (EPPM), an interactive qualitative approach was used to code the data into substantive and theoretical categories to describe the participants' concepts and beliefs related to subsequent injury and communication about injury prevention. All participants described at least one injury or near-injury event since their initial SCI. Most participants perceived injuries as a threat, particularly to time loss and loss of independence. Participants described feeling susceptible due to functional ability, sensory impairments, and their environment related to accessibility, weather, and emergencies. Overall, individuals with SCI recognized the importance of subsequent injury prevention, and were willing to take actions to prevent injuries. Increased self-efficacy to prevent subsequent injury was linked to better motor function, more time since initial SCI, more self-confidence and knowing the limits. The response-efficacy of formal and informal policies to prevent injury was mixed, especially when implemented without participant input. In conclusion, perceptions of threat and efficacy are important considerations in the development of messages to prevent subsequent injury among individuals with SCI.