This overview of the literature captures the key characteristics of the existing intervention programs for SM post-SCI. Program topic-wise, it is worth noting that 40% of SCI SM programs focused on only one specific secondary condition. This may reflect the underlying complexity and challenges of managing multiple secondary health complications in the SCI population. Although some SM skills, such as identifying issues, setting goals, and measuring achievement, may be transferrable across different secondary health conditions, certain behavioural skills required may vary depending on the type and nature of the health condition.
As identified in the previous sections, SCI SM programs were often delivered by peers and healthcare professionals, such as nurses, psychologists, and, occupational therapists. The benefits of peer involvement in SCI SM interventions have been well documented in the literature. The lived experiences of and social support from those with similar conditions can be especially empowering for program participants and have been shown to enhance self-esteem, improve vocational outcomes, and reduce hospital readmission in individuals with SCI. The active engagement of clinicians and other healthcare professionals is also a key contributor of the success of many SCI SM interventions. It should be noted that when delivering SM programs, it is crucial for healthcare professionals to appropriately position their role and find a delicate balance between exercising control and providing patients with autonomy to take control over the management of their own conditions.
In terms of location of program delivery, besides traditional settings such as rehabilitation hospitals, rehabilitation centers, and communities, a significant
percentage of SCI SM intervention programs, especially the more recent ones, were delivered virtually via the Internet. In fact, this wide utilization of virtual delivery methods in the implementation of SM programs aligns with the preferences of many patients with SCI. In a qualitative study examining participants’ views on SM program delivery conducted with 99 Canadians with traumatic SCI, the Internet was considered as the preferred method of program delivery by 40% of the participants. Virtual delivery methods may be especially ideal for individuals with SCI who experience significant limitations in mobility and should continue to be utilized in future SCI SM program delivery to improve program accessibility and patient engagement. At the same time, it is worth noting that participating in virtual SM programs often requires participants to have access to newer models of electronic devices and a certain level of e-health literacy, which may pose financial and technological challenges for some individuals with SCI, especially those from lower socioeconomic background and older adults. Therefore, in-person SCI SM programs should not be replaced by online-based programs completely in the near future.
Regarding the utilization of established components of SM across interventions, while some SM components were embedded in the intervention programs more frequently than others, all components from each of the three taxonomies were utilized by at least one program. The distribution of utilization of the SM components from Barlow and colleagues’ taxonomy and the PRISMS taxonomy reveals that the existing SM interventions for SCI were primarily concerned with providing patients with information about condition and symptom management and psychological training, which were often achieved through the use of information booklets as well as group and/or individual education sessions. These foci are consistent with SM programs’ traditional emphasis on facilitating symptom management and behavioural changes through education.
From the perspectives of individuals with SCI and their caregivers, facilitators of SM include physical and emotional support from caregivers, support and feedback from peers, acceptance of one’s condition and positive outlook towards the future, and the ability to maintain independence and control over ones own care. Barriers of SM consist of caregiver burnout, inadequate funding and associated policies that promote quality of life post-SCI, physical limitations resulted from SCI and its secondary health conditions, lack of accessibility, and challenges related to psychosocial adaptation. These findings suggest that successful SM interventions for SCI should not only promote self-care skills and lifestyle changes but also place emphasis on self-advocacy skills and coping skills. Further, they should integrate a wider range of components of SM to achieve the best outcomes. In order to maximize the facilitators of SM and address the barriers, SM program developers and implementation teams should engage diverse stakeholders, including but not limited to individuals with SCI, caregivers, and health and social service providers in the development, and/or delivery of SCI SM interventions.