Barriers and facilitators to employment after spinal cord injury: underlying dimensions and their relationship to labor force participation

Abstract

Study design: Cross-sectional survey. Objective: To identify barriers and facilitators to employment after spinal cord injury (SCI) and their relationship with labor force participation. Methods: Participants were initially identified through specialty hospitals in the Midwest and Southeastern United States of America. 781 adults with traumatic SCI, at least 1 year post-injury, and between the ages of 18-64, participated. A 30-item instrument on barriers and facilitators to employment was administered. Analyses included exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and comparisons of scores as a function of employment status. Results: EFA indicated six primary themes (root mean square error of approximation (RMSEA) ¼ 0.040), including: (a) resources, (b) health status, (c) disability considerations, (d) lack of importance, (e) disincentives and (f) motivation. CFA indicated an acceptable fit (RMSEA ¼ 0.078). Univariate analyses indicated each item and factor was significantly different as a function of labor force participation. After controlling for biographical and injury factors, multinomial logistic regression indicated three factors significantly differentiated those never employed, those currently unemployed but had worked since injury and those currently employed. Those employed reported higher scores for resources and motivation and lower scores for lack of importance. Conclusions: Barriers and facilitators were consistently related to labor force participation, with facilitators more highly related to labor force participation than barriers. Although loss of financial and medical benefits (disincentives) as well as health status have been reported as barriers to employment, they were not as highly correlated with labor force participation as were other factors.

Integrated services and early intervention in the vocational rehabilitation of people with spinal cord injuries

“…29 Hope also enhances coping and psychosocial adjustment. 30 This was observed in NSW In-Voc programme of which early intervention was a feature: participants retained stable quality of life scores during a time when it would be expected to decrease.…”

To work or not to work: labour market participation of people with spinal cord injury living in Switzerland

“…5 Frequently found factors associated with LMP in SCI are gender, marital status, education, disability severity, age, time since onset of SCI, social support, vocational counselling, perceived health and pain. 2,3,[5][6][7][8][9] However, the existing evidence on determinants of LMP in SCI is inconsistent. Although in some studies injury severity and gender are associated with LMP, others show the contrary.…”

Return-to-work intentions during spinal cord injury rehabilitation: an audit of employment outcomes

“…4,5 The lack of intention for those with SCI to return to work gives cause for major concern, as both the physical and psychological health benefits, and improved quality and duration of life post-injury, are well documented advantages of resuming employment. 1,6 Not only has there not been an increase in the proportion of individuals with SCI gaining employment after rehabilitation, as one might expect given the awareness of this issue and the well-established benefits of doing so, but the percentage of people returning to work post-injury may have actually decreased over the years. Guttmann 7 reported in 1954 that 69% of 752 paraplegics were employed, with 78% of these working full-time.…”

“…Psychological and psychosocial barriers also exist, such as 'Most employers will not hire me because of my disability' or 'The types of jobs that I can do now just do not interest me'. 6 These are complex issues which need to be appropriately addressed throughout the rehabilitation process if successful employment outcomes are to be achieved. Finally, the loss of financial benefits or welfare associated with disability (or in some cases accident compensation) is an economic barrier to employment for some people with SCI, who are disincentivised from returning to work as it might mean a loss of benefits.…”

“…Finally, the loss of financial benefits or welfare associated with disability (or in some cases accident compensation) is an economic barrier to employment for some people with SCI, who are disincentivised from returning to work as it might mean a loss of benefits. 2,6 The concept of implementation intentions-plans which enhance the translation of goal intentions into actions-has been studied in the context of health behaviours by Gollwitzer and Sheeran. 21,22 Research has found a significant association between participants' goal intentions and behavioural outcomes; however, one study found that people translated their good intentions into actions only 53% of the time.…”