Online Health Coaching for Spinal Cord Injury: Results from a Mixed Methods Feasibility Evaluation (Preprint)
JMIR Rehabilitation and Assistive Technologies
Individuals with spinal cord injury (SCI) have a high risk of experiencing secondary conditions like pressure injuries. Self-management programs may reduce the risk of such complications, but traditional programs have proven to be insufficiently tailored to the needs of people with SCI. To overcome barriers to self-management support, an online self-management program was developed for Canadians with SCI called "SCI&U". To evaluate the feasibility and potential impact of the "SCI&U" program in
... "SCI&U" program in the context of a mixed-methods pilot study. The study followed an explanatory sequential mixed-methods design. Participants (N=11) were Canadians with SCI who had been living in the community for more than 1 year. Each took part in a self-paced, 6-session self-management program guided by a trained peer health coach. During most sessions participants could elect to discuss a health topic with their coach from a pre-defined list (e.g. Skin or Bowel Management). Quantitative data was gathered before and after program participation to assess program feasibility and impact; feasibility measures included attrition rates, frequency of health topics selected and recorded goals, while impact measures included measures of self-efficacy (UW-SES), mood (PHQ-8), secondary conditions (SCI-SCS) and resilience (SCI-QOL-R). Qualitative measures were based on post-intervention interviews; these were designed to confirm and expand upon quantitative results. Synthesis of quantitative and qualitative results was conducted at the reporting and interpretation level. Of 11 participants, 10 completed pre- and post-assessments and 6 coaching sessions. Sessions lasted between 31 and 81 minutes (average 55 minutes) and the duration of the program ranged from 35 to 88 days (average 56 days). Diet and exercise were selected as health topics 40% of the time; mental health, bladder, pain and bowel management topics were chosen but less frequently. Pre- and post results demonstrated improvements with moderate effect sizes on the UW-SES and eHEALS (i.e. Hedges' g > 0.5). Effect sizes for measures of resilience (SCI-QOL-R), depression (PHQ-8) and secondary conditions (SCI-SCS) were small (i.e. Hedges' g > 0.3). Qualitative results confirmed a common focus on diet and exercise and defined coaches as sources of accountability, information, reassurance/affirmation, emotional and technical support. Results demonstrate an online self-management program to be feasible and acceptable by Canadians with SCI. Results also indicate the potential for online, peer-led self-management programs to impact resilience, self-efficacy, mood and secondary complications. Finally, results illuminate the role of the coach in facilitating behaviour change. Future work seeks to validate these results in the context of a randomized controlled trial.