Ethics code: IR.USWR.REC.1401.207
1- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
2- Department of Occupational Therapy, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
2- Department of Occupational Therapy, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
Abstract: (80 Views)
Objective(s): Health is a fundamental human right; however, individuals with spinal cord injuries generally experience poorer health compared to the wider population. The goal of this research was to explain barriers and facilitators of accessing rehabilitation services within the healthcare system for individuals with spinal cord injuries in Iran.
Methods: This study was conducted using a qualitative paradigm and conventional content analysis approach. The participants were 14 individuals with spinal cord injuries, their caregivers, and rehabilitation specialists selected through purposive sampling. Sampling was carried out until the point of data saturation being reached. Information was collected and analyzed through individual, in-depth, and semi-structured interviews. Data categorization was performed using MAXQDA 2020 software.
Results: Analyzing the participants' experiences resulted in the discovery of 701 codes. Barriers were classified into 4 main categories: “economic hardships”, “restrictive environment”, “disruption of social and cultural interactions” and “organizational heterogeneity”. Facilitating factors include 2 main categories of “supportive community”, and “reliance on individual abilities”.
Conclusion: According to the research findings, individuals with spinal cord injuries face many barriers in accessing rehabilitation services. Conversely, there are factors at the family, social, and individual levels that facilitate their access. Most participants considered economic hardships and the restrictive environment as the most important barriers to accessing rehabilitation services. All agreed that a supportive society and reliance on individual capabilities have facilitated access to these services. Therefore, it is recommended to carefully formulate and plan to reduce economic bottlenecks, carry out coordinated organizational interventions, and provide the necessary conditions to upgrade the urban environment according to the abilities of individuals with spinal cord injuries.
Methods: This study was conducted using a qualitative paradigm and conventional content analysis approach. The participants were 14 individuals with spinal cord injuries, their caregivers, and rehabilitation specialists selected through purposive sampling. Sampling was carried out until the point of data saturation being reached. Information was collected and analyzed through individual, in-depth, and semi-structured interviews. Data categorization was performed using MAXQDA 2020 software.
Results: Analyzing the participants' experiences resulted in the discovery of 701 codes. Barriers were classified into 4 main categories: “economic hardships”, “restrictive environment”, “disruption of social and cultural interactions” and “organizational heterogeneity”. Facilitating factors include 2 main categories of “supportive community”, and “reliance on individual abilities”.
Conclusion: According to the research findings, individuals with spinal cord injuries face many barriers in accessing rehabilitation services. Conversely, there are factors at the family, social, and individual levels that facilitate their access. Most participants considered economic hardships and the restrictive environment as the most important barriers to accessing rehabilitation services. All agreed that a supportive society and reliance on individual capabilities have facilitated access to these services. Therefore, it is recommended to carefully formulate and plan to reduce economic bottlenecks, carry out coordinated organizational interventions, and provide the necessary conditions to upgrade the urban environment according to the abilities of individuals with spinal cord injuries.
type of study: Qualitative Study |
Subject:
Helath Services Management
Received: 2024/08/7 | Accepted: 2025/09/20 | ePublished ahead of print: 2025/10/28
Received: 2024/08/7 | Accepted: 2025/09/20 | ePublished ahead of print: 2025/10/28
References
1. Perrouin-Verbe B, Lefevre C, Kieny P, Gross R, Reiss B, Le Fort M. Spinal cord injury: A Multisystem physiological impairment/dysfunction. Revue Neurologique 2021; 177: 594-605 [DOI:10.1016/j.neurol.2021.02.385]
2. Shang Z, Wanyan P, Zhang B, Wang M, Wang X. Incidence and risk factors of deep vein thrombosis in patients with spinal cord injury: A Systematic review with meta-analysis. Frontiers in Cardiovascular Medicine 2023; 10:1-12 [DOI:10.3389/fcvm.2023.1153432]
3. Lo J, Chan L, Flynn S. A Systematic review of the incidence, prevalence, costs, and activity and work limitations of amputation, osteoarthritis, rheumatoid arthritis, back pain, multiple sclerosis, spinal cord injury, stroke, and traumatic brain injury in the United States. Archives of Physical Medicine and Rehabilitation 2021; 102: 115-131 [DOI:10.1016/j.apmr.2020.04.001]
4. Merritt CH, Taylor MA, Yelton CJ, Ray SK. Economic impact of traumatic spinal cord injuries in the United States. Neuroimmunology and Neuroinflammation 2019; 6: 1-16 [DOI:10.20517/2347-8659.2019.15]
5. Tough H, Fekete C, Brinkhof MWG, Siegrist J. Vitality and mental health in disability: Associations with social relationships in persons with spinal cord injury and their partners. Disability and Health Journal 2017; 10: 294-302 [DOI:10.1016/j.dhjo.2016.12.008]
6. Barclay L, McDonald R, Lentin P, Bourke‐Taylor H. Facilitators and barriers to social and community participation following spinal cord injury. Australian Occupational Therapy Journal 2016; 63: 19-28 [DOI:10.1111/1440-1630.12241]
7. Farahbakhsh F, Rezaei Aliabadi H, Baigi V, Ghodsi Z, Dashtkoohi M, Pour-Rashidi A, et al. Pressure ulcers and acute risk factors in individuals with traumatic spinal fractures with or without spinal cord injuries: A Prospective analysis of the national spinal cord injury registry of Iran data. Chinese Journal of Traumatology 2023; 26: 193-198 [DOI:10.1016/j.cjtee.2023.03.007]
8. Conti A, Clari M, Nolan M, Wallace E, Tommasini M, Mozzone S, et al. The relationship between psychological and physical secondary conditions and family caregiver burden in spinal cord injury: A Correlational study. Topics in Spinal Cord Injury Rehabilitation 2019; 25: 271-280 [DOI:10.1310/sci2504-271]
9. Richardson A, Samaranayaka A, Sullivan M, Derrett S. Secondary health conditions and disability among people with spinal cord injury: A Prospective cohort study. The Journal of Spinal Cord Medicine 2021; 44: 19-28 [DOI:10.1080/10790268.2019.1581392]
10. North N. The psychological effects of spinal cord injury: A review. Spinal Cord 1999; 37: 671-679 [DOI:10.1038/sj.sc.3100913]
11. Anderson D, Dumont S, Azzaria L, Bourdais ML, Noreau L. Determinants of return to work among spinal cord injury patients: A literature review. Journal of Vocational Rehabilitation 2007; 27: 57-68 [DOI:10.3233/JVR-2007-00385]
12. Hachem LD, Ahuja CS, Fehlings MG. Assessment and management of acute spinal cord injury: From point of injury to rehabilitation. Journal of Spinal Cord Medicine 2017; 40: 665-675 [DOI:10.1080/10790268.2017.1329076]
13. Pendleton HM, Schultz-Krohn W. Pedretti's occupational therapy: Practice skills for physical dysfunction. 9st Edition, Elsevier Health Sciences: California, 2024
14. Organization WH. Rehabilitation https://www.who.int/news-room/fact-sheets/detail/rehabilitation 2022. Accessed April 2022; 23
15. Bychkovska O, Strøm V, Tederko P, Engkasan JP, Juocevičius A, Battistella LR, et al. Health system's role in facilitating health service access among persons with spinal cord injury across 22 countries. International Journal of Environmental Research and Public Health 2023; 20: 56-60 [DOI:10.3390/ijerph20116056]
16. Soltani S, Takian A, Akbari Sari A, Majdzadeh R, Kamali M. Financial barriers to access to health services for adult people with disability in Iran: The challenges for universal health coverage. Iranian Journal of Public Health 2019; 48: 508-515 [DOI:10.18502/ijph.v48i3.895]
17. Shirazikhah M, Harouni GG, Shirazikhah A, Noroozi M, Sajadi HS. Access to physical rehabilitation services among people with disabilities: Results of a national study in Iran. Koomesh Journal 2022; 24: 596-604 [Persian]
18. Soltani S, Arvan K, Karami Matin B, Ghoddoosinejad J, Moradi F, Salehiniya H. People with disabilities and financial challenges in access to rehabilitation services: Evidence of socioeconomic inequality in Iran. Medical Journal of the Islamic Republic of Iran 2024; 38: 202-209 [DOI:10.47176/mjiri.38.31]
19. Shirazikhah M, Roshanfekr P, Takian A, Alizadeh Zarei M, Shirazikhah A, Joghataei MT. Availability of physical rehabilitation facilities for people with disabilities in Iran: A Comparative study on universal health coverage. Archives of Iranian Medicine 2022; 25: 698-705 [DOI:10.34172/aim.2022.109]
20. Soltani S, Moghadam MM, Amani S, Akbari S, Shiani A, Soofi M. Socioeconomic disparities in using rehabilitation services among Iranian adults with disabilities: A Decomposition analysis. BMC Health Services Research 2022; 22: 1-10 [DOI:10.1186/s12913-022-08811-8]
21. Karami Matin B, Kamali M, Williamson HJ, Moradi F, Solatni S. The predictors of access to health services for people with disabilities: A Cross-sectional study in Iranian context. Medical Journal of the Islamic Republic of Iran 2019; 33: 751-756 [DOI:10.47176/mjiri.33.125]
22. Farahbod M, Masoudi Asl I, Tabibi SJ, Kamali M. The status of rehabilitation in Iran: Barriers and facilitators. Iranian Journal of Ageing 2023; 18: 218-233 [Persian] [DOI:10.32598/sija.2023.2535.1]
23. Mandani G, Ghafarzadeh Namazi N, Akbarfahimi N. Factors facilitating access to rehabilitation services for individuals with spinal cord injuries during the COVID-19 pandemic. Journal of Qualitative Research in Health Sciences 2024; 13: 98-105 [DOI:10.34172/jqr.2024.14]
24. Abdi K, Arab M, Rashidian A, Kamali M, Khankeh HR, Farahani FK. Exploring barriers of the health system to rehabilitation services for people with disabilities in Iran: A Qualitative study. Electronic Physician 2015; 7: 1476-1485 [DOI:10.19082/1476]
25. Abdi K, Arab M, Khankeh HR, Kamali M, Rashidian A, Farahani FK, et al. Challenges in providing rehabilitation services for people with disabilities in Iran: A Qualitative study. Journal of Advances in Medicine and Medical Research 2016; 13: 1-11 [DOI:10.9734/BJMMR/2016/23337]
26. Pashaei Sabet F, Norouzi Tabrizi K, Saadat S, Khankeh HR, Abedi HA, Danial Z. Perception from barrier and facilitator for providing early rehabilitation care for RTI victims. Journal of Trauma and Emergency Medicine 2015; 20: 216-221 [DOI:10.5812/traumamon.21621v2]
27. Ayyoubian M, Abdollahi I, Amiri M. Study cause of SCI in client user of rehabilitation services. Archives of Rehabilitation 2005; 5: 18-23 [Persian]
28. Shamshiri M, Eskandar Oghli B, Vafaee M, Molaei B. Adaptive coping strategies in patients with spinal cord injury: A Phenomenological study. Iranian Journal of Psychiatry and Clinical Psychology 2021; 26: 478-489 [Persian] [DOI:10.32598/ijpcp.26.3.2975.1]
29. Razzaghi V, Ostadhashemi L, Arshi M, Sabzi Khoshnami M. Exploring the facilitators and barriers of social integration of patients with spinal cord injuries in Rofeideh rehabilitation hospital: A Qualitative study. Archives of Rehabilitation 2022; 23:482-501 [Persian] [DOI:10.32598/RJ.23.4.3398.1]
30. Nikbakht A, Bastami A, Norouzi Tabrizi K, Pashaei Sabet F, Gomarverdi S. Exploring home-based rehabilitation in traumatic spinal cord injury patients: A Qualitative Study. Iranian Journal of Nursing Research 2017; 11: 32-41 [Persian] [DOI:10.21859/ijnr-11065]
31. Bastami A, Pashaii Sabet F, Qomarverdi S, Nikbakht Nasraabadi A. Review study of requirements for a model for home-based rehabilitation of traumatic spinal cord injury. Iranian Journal of Nursing Research 2017; 12: 45-49 [Persian]
32. Mlenzana NB, Frantz JM, Rhoda AJ, Eide AH. Barriers to and facilitators of rehabilitation services for people with physical disabilities: A Systematic review. African Journal of Disability 2013; 2: 1-6 [DOI:10.4102/ajod.v2i1.22]
33. Maart S, Jelsma J. Disability and access to health care-a community based descriptive study. Disability and Rehabilitation 2014; 36: 1489-1493 [DOI:10.3109/09638288.2013.807883]
34. Conti A, Dimonte V, Rizzi A, Clari M, Mozzone S, Garrino L, et al. Barriers and facilitators of education provided during rehabilitation of people with spinal cord injuries: A Qualitative description. PLOS ONE 2020; 15: 1-14 [DOI:10.1371/journal.pone.0240600]
35. Kleinheksel A, Rockich-Winston N, Tawfik H, Wyatt TR. Demystifying content analysis. American Journal of Pharmaceutical Education 2020; 84: 127-137 [DOI:10.5688/ajpe7113]
36. O'Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: A Synthesis of recommendations. Academic Medicine 2014; 89: 1245-1251 [DOI:10.1097/ACM.0000000000000388]
37. Ansari, Noureddin Nakhostin, et al. Validation of a mini-mental state examination for the Persian population: A Pilot study. Applied Neuropsychology 2010; 17: 190-195
38. Naveen SR. Quality of life in traumatic spinal cord injured. Journal of Evidence-Based Medicine and Healthcare 2016; 3: 176-183 [DOI:10.18410/jebmh/2016/42]
39. Patton MQ. Qualitative research. Encyclopedia of Statistics in Behavioral Science 2005; 3: 1633-1636 [DOI:10.1002/0470013192.bsa514]
40. Polit D, Beck C. Essentials of nursing research: Appraising evidence for nursing practice. 10st Edition, Lippincott Williams & Wilkins: United States, 2020
41. Lincoln YS, Lynham SA, Guba EG. Paradigmatic controversies, contradictions, and emerging confluences, revisited. SAGE Handbook of Qualitative Research 2011; 4: 97-128
42. Johnson RL, Gerhart KA, McCray J, Menconi JC, Whiteneck GG. Secondary conditions following spinal cord injury in a population-based sample. Spinal Cord 1998; 36: 45-50 [DOI:10.1038/sj.sc.3100494]
43. Racher FE, Vollman AR. Exploring the dimensions of access to health services: Implications for nursing research and practice. Research and Theory for Nursing Practice 2002; 16: 77-90 [DOI:10.1891/rtnp.16.2.77.53003]
44. Tsai I, Graves DE, Chan W, Darkoh C, Lee M-S, Pompeii LA. Environmental barriers and social participation in individuals with spinal cord injury. Rehabilitation Psychology 2017; 62: 36-44 [DOI:10.1037/rep0000117]
45. Akyuz M, Yalcin E, Selcuk B, Degirmenci I. The barriers limiting the social integration of wheelchair users with spinal cord injury in Turkish society. Neurosurgery Quarterly 2014; 24: 225-228 [DOI:10.1097/WNQ.0000000000000116]
46. Hashemiparast M, Sheydaei H, Gharacheh M. The lived experience of physical-motor disability due to traffic accidents: A Phenomenological study. Iranian Journal of Health Education and Health Promotion 2021; 9: 20-32 [Persian] [DOI:10.52547/ijhehp.9.1.20]
47. Giraldo-Rodríguez L, Mino-León D, Murillo-González JC, Agudelo-Botero M. Factors associated with environmental barriers of people with disabilities in Mexico. Revista de Saúde Pública 2019; 53: 1-11 [DOI:10.11606/S1518-8787.2019053000556]
48. Tozandejani H. Examination and analysis of the created employment on the social, economical and cultural condition of the target society of Khorasane Razavi province behzisti organization. Journal of Educational Psychology 2009; 1: 1-12
49. Najafi Z, Abdi K, Khanjani MS, Dalvand H, Amiri M. Convention on the rights of persons with disabilities: Qualitative exploration of barriers to the implementation of articles 25 [health] and 26 [rehabilitation] in Iran. Medical Journal of the Islamic Republic of Iran 2021; 35: 78-86 [DOI:10.47176/mjiri.35.10]
50. Croft S, Fraser S. A Scoping review of barriers and facilitators affecting the lives of people with disabilities during COVID-19. Frontiers in Rehabilitation Sciences 2022; 2: 1-14 [DOI:10.3389/fresc.2021.784450]
51. Branjerdporn G, Kimball H, Pirotta R, Branjerdporn N, Collins T, Bowman G, et al. Characteristics and outcomes of community-based perinatal peer support: Protocol for a systematic review. PLOS ONE 2024; 19: 1-7 [DOI:10.1371/journal.pone.0303277]
52. Rashidi K, Safavi M, Yahyavi SH, Farahani H. The effect of the peers' support on self-efficacy level type II diabetic patients. Avicenna Journal of Nursing and Midwifery Care 2015; 23: 15-26 [Persian]
53. Von Lengerke T, Gohl D, Babitsch B. Re-revisiting the behavioral model of health care utilization by Andersen: A Review on theoretical advances and perspectives. In: Janssen C, Swart E, eds. Health Care Utilization in Germany. Springer: New York, 2014: 11-28 [DOI:10.1007/978-1-4614-9191-0_2]
54. Ryan RM, Deci EL. Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions, theory, practices, and future directions. Contemporary Educational Psychology 2020; 61: 1-11 [DOI:10.1016/j.cedpsych.2020.101860]
55. Du H, Bernardo AB, Yeung SS. Locus-of-hope and life satisfaction: The mediating roles of personal self-esteem and relational self-esteem. Personality and Individual Differences 2015; 83: 228-233 [DOI:10.1016/j.paid.2015.04.026]
56. Waddington J. Self-efficacy. English Language Teaching Journal 2023; 77: 237-240 [DOI:10.1093/elt/ccac046]
57. Baehr LA, Kaimal G, Hiremath SV, Trost Z, Finley M. Staying active after rehab: Physical activity perspectives with a spinal cord injury beyond functional gains. PLOS ONE 2022; 17: 1-13 [DOI:10.1371/journal.pone.0265807]
58. Middleton J, Tran Y, Craig A. Relationship between quality of life and self-efficacy in persons with spinal cord injuries. Archives of Physical Medicine and Rehabilitation 2007; 88: 1643-1648 [DOI:10.1016/j.apmr.2007.09.001]
59. Li Y, Chien WT, Zhu B, He H, Bressington D. Predictors of self‐efficacy among people with spinal cord injury during inpatient rehabilitation: A Cross‐sectional study. Journal of Nursing Scholarship 2021; 53: 218-226 [DOI:10.1111/jnu.12632]
Send email to the article author
| Rights and Permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |