Sources of Injustice among Individuals Living with Spinal Cord Injury
1Monden K, 1Philippus A, 2Trost Z
1Craig Hospital, Englewood, CO, USA; 2University of Alabama at Birmingham, Birmingham, AL, USA
Individuals who sustain physical injury or illness with accompanying secondary conditions, such as reduced mobility and persistent pain, often perceive themselves as victims of injustice. Injustice perception is defined as the severity and irreparability of injury or condition-related loss, perceived unfairness, and externalized blame and is conceptualized to arise naturally from disruptive health experiences. A growing body of evidence support elevated injustice perception/appraisals as a critical cognitive-behavioral risk factor for development and maintenance of persistent pain, disability, and psychological distress following musculoskeletal/neurological injury. The impact of injustice perception in SCI and other injury populations is notable in that it predicts poorer physical and psychosocial outcomes over and above demographic and clinical/injury-related factors, and established risk factors like depression.
A number of studies indicate that perceived injustice contributes to problematic recovery outcomes following musculoskeletal injury. Several intervention strategies have been suggested, including anger management, forgiveness-based interventions, and acceptance and commitment therapy, however, research is needed to test the efficacy of these interventions. While findings suggest that perceived injustice is an important risk factor for negative outcomes following SCI and rehabilitation, no existing interventions address injustice appraisals. Before developing an intervention it is important to develop an understanding of the sources of perceived injustice. To date, there has only been one investigation into the sources of perceived injustice and this study was in a chronic pain population. Therefore, the purpose of the proposed presentation is to introduce results from a qualitative inquiry into the sources of/contributing factors of perceived injustice following SCI.
Participants included in this study are males or females aged 18 years or older, have sustained a traumatic SCI as defined by the SCI Model Systems (MS) program, and have completed either their one or five year SCI MS follow-up interview. Participants are asked to complete the 12-item Injustice Experience Questionnaire (IEQ) via telephone and then take part in individual, semi-structured interviews to explore in greater depth their experiences of injustice following SCI. Open ended questions were developed based on items of the IEQ and participants are asked to discuss their reasons for identifying, or not identifying, specific individuals, groups, or circumstances as sources of injustice. Currently, seven individuals have completed individual semi-structured qualitative interviews. Data collection will continue until topic saturation is reached, which is estimated to be approximately 15-20 individuals living with SCI.
Ongoing qualitative data analysis involves coding and categorizing the data to look for distinct concepts and categories in the data that accurately reflect the interview responses. The concepts and themes that emerge, and their interrelationships, will be combined to tell a story that characterizes perceptions of injury-related injustice.
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