Chang Feng-Hang, Liu Cheng-Han, Hung Hsin-Ping
a Graduate Institute of Injury Prevention and Control , College of Public Health, Taipei Medical University , Taipei , Taiwan.
b Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine , Taipei Medical University , Taipei , Taiwan.
Disabil Rehabil. 2018 Sep;40(18):2192-2199. doi: 10.1080/09638288.2017.1327991. Epub 2017 May 22.
To identify environmental factors associated with participation and gain an in-depth understanding of relationships between environmental factors and participation among people with spinal cord injury.
Six focus groups (n= 30) with individuals with spinal cord injury were conducted. Two independent coders thematically analyzed the transcribed data.
Twenty environmental factors were identified, all of which were classified into eight categories: built environment; natural environment; assistive technology; transportation; information and technology access; economics; social support and social attitudes; and systems, services and policies. While all factors had direct impacts on individuals' participation outcomes, factors within the categories of societal attitudes, policies and economics also affected participation through affecting other environmental factors. Some factors together also showed cumulative or countering effects on participation. Accordingly, a conceptual model of the relationships between environmental factors and participation was constructed.
This study highlighted key environmental factors and their impacts on participation of people with spinal cord injury. The findings support previous research findings but also suggest that different factors may have different levels of impact on participation. Based on our findings, rehabilitation practitioners and policymakers can prioritize intervention plans to optimize the environment for people with spinal cord injury and improve their societal participation. Implications for rehabilitation Environmental factors are critical contributors to participation among people with spinal cord injury (SCI) and need to be addressed in rehabilitation programs. Factors with broader impacts on participation, such as societal attitudes and policies, should be treated as priorities in intervention plans aimed at improving participation among people with SCI. Rehabilitation practitioners should not only consider how the community supports people with SCI but also consider how rehabilitation programs change the community.
确定与参与相关的环境因素，并深入了解脊髓损伤患者环境因素与参与之间的关系。
对脊髓损伤患者进行了6个焦点小组（n = 30）访谈。两名独立编码员对转录数据进行了主题分析。
确定了20个环境因素，所有因素分为八类：建筑环境；自然环境；辅助技术；交通；信息与技术获取；经济；社会支持与社会态度；以及系统、服务和政策。虽然所有因素都对个体的参与结果有直接影响，但社会态度、政策和经济类别中的因素也通过影响其他环境因素来影响参与。一些因素共同作用时对参与也显示出累积或抵消效应。据此，构建了环境因素与参与之间关系的概念模型。
本研究突出了关键环境因素及其对脊髓损伤患者参与的影响。研究结果支持先前的研究发现，但也表明不同因素对参与可能有不同程度的影响。基于我们的研究结果，康复从业者和政策制定者可以优先制定干预计划，以优化脊髓损伤患者的环境并提高他们的社会参与度。对康复的启示 环境因素是脊髓损伤患者参与的关键因素，需要在康复计划中加以解决。对参与有更广泛影响的因素，如社会态度和政策，应在旨在提高脊髓损伤患者参与度的干预计划中作为优先事项对待。康复从业者不仅应考虑社区如何支持脊髓损伤患者，还应考虑康复计划如何改变社区。
