Brain injuries (BI) are the leading cause of death and disability among people under the age of 45 (Ontario Brain Injury Association, 2004). With improved survival rates, more individuals each year return to the community with impairments and disabilities caused by their injury (Smith, Magill–Evans, and Brintnell, 1998). Adjusting to these impairments may affect the individual’s subjective well being; therefore, attention to community reintegration by researchers, policy developers, and health care providers is important. Using qualitative research methods and systems theory as the theoretical framework, the purpose of the study was to examine community reintegration from the perspectives of three key groups: individuals with BI, community based agencies, and primary care physicians regarding the meaning attributed to “successful reintegration”, as well as the key characteristics and barriers experienced during reintegration. “Successful” reintegration appears to be an individually derived concept. Participants consistently identified the need for information about the process of community reintegration, and resources available both during rehabilitation and after discharge from the hospital as being both a key aspect of community reintegration, as well as a barrier experienced during the return to community. / October 2006

Brain injuries (BI) are the leading cause of death and disability among people under the age of 45 (Ontario Brain Injury Association, 2004). With improved survival rates, more individuals each year return to the community with impairments and disabilities caused by their injury (Smith, Magill–Evans, and Brintnell, 1998). Adjusting to these impairments may affect the individual’s subjective well being; therefore, attention to community reintegration by researchers, policy developers, and health care providers is important. Using qualitative research methods and systems theory as the theoretical framework, the purpose of the study was to examine community reintegration from the perspectives of three key groups: individuals with BI, community based agencies, and primary care physicians regarding the meaning attributed to “successful reintegration”, as well as the key characteristics and barriers experienced during reintegration. “Successful” reintegration appears to be an individually derived concept. Participants consistently identified the need for information about the process of community reintegration, and resources available both during rehabilitation and after discharge from the hospital as being both a key aspect of community reintegration, as well as a barrier experienced during the return to community.

Brain injuries (BI) are the leading cause of death and disability among people under the age of 45 (Ontario Brain Injury Association, 2004). With improved survival rates, more individuals each year return to the community with impairments and disabilities caused by their injury (Smith, Magill–Evans, and Brintnell, 1998). Adjusting to these impairments may affect the individual’s subjective well being; therefore, attention to community reintegration by researchers, policy developers, and health care providers is important. Using qualitative research methods and systems theory as the theoretical framework, the purpose of the study was to examine community reintegration from the perspectives of three key groups: individuals with BI, community based agencies, and primary care physicians regarding the meaning attributed to “successful reintegration”, as well as the key characteristics and barriers experienced during reintegration. “Successful” reintegration appears to be an individually derived concept. Participants consistently identified the need for information about the process of community reintegration, and resources available both during rehabilitation and after discharge from the hospital as being both a key aspect of community reintegration, as well as a barrier experienced during the return to community.

Magister Scientiae (Physiotherapy) - MSc(Physio) / A traumatic spinal cord injury (TSCI) often occurs unexpectedly and causes considerable disability. This condition requires specialized care that is delivered in a time sensitive manner. Data on the incidence, causes, mortality and injury characteristics of TSCI are important for gauging demand for health care and social support services. Unfortunately data on the incidence and causes, as well as functioning such as participation and integration into society, of TSCI are sparse in developing countries such as Tanzania. The overall aim of this study is to determine the incidence, causes, mortality and injury characteristics of TSCI, and to explore the challenges experienced with community reintegration after injury in Tanzania. Both quantitative and qualitative research paradigms were used. The quantitative phase of the study was conducted at Kilimanjaro Christian Medical Centre (KCMC), a referral and teaching hospital in northern Tanzania. The study population was all patients admitted to KCMC with a TSCI from 1 January 2011 to 31 December 2015 (five year period). Quantitative data were collected retrospectively using a data extraction sheet designed by the International Spinal Cord Society which consisted of the following sections: participants’ characteristics (for example age, gender, duration of hospital stay, causes of injury and vertebral injuries) and injury characteristics (location of injury and completeness of injury). Differences between groups (stratified by year) was analysed using both descriptive and inferential statistics. The population for the qualitative phase was based on those included in the quantitative phase. Purposive sampling was used to select adults (over the age of 18 years) with TSCI who were managed at KCMC. Qualitative data were collected by means of individual, semi-structured interviews, and lasted until theoretical saturation was achieved. Thematic analysis was used to derive themes (categories) explaining the latent perceptions of community reintegration and its influences.

Philosophiae Doctor - PhD / Spinal cord injury (SCI) is a devastating condition often affecting young and healthy individuals around the world. This debilitating condition not only creates enormous physical and emotional suffering to individuals but also is a significant financial burden to families and society at large and it affects quality of life. Successful community reintegration following spinal cord injury is considered an important goal of rehabilitation as this has been positively associated with self-esteem, life satisfaction and quality of life. The overall aim of the study was to design a community reintegration programme for individuals who sustained a traumatic spinal cord injury (TSCI) in the Cape Metropolitan Area. The design of this study was a mixed method design including four phases. The first phase of the study was to determine the base line information regarding reintegration into communities after sustaining a TSCI and included 108 participants. Data was collected by use of self-administered/interview administered questionnaire. The results of this phase demonstrated that community reintegration of individuals who sustained a traumatic spinal cord injury was relatively low and employment was found to be a statistically significant variable influencing community reintegration following the injury. The second phase of the study aimed to gain a deeper understanding of how employment and other factors influence reintegration into communities after the injury.

<p>Since 2004, there has been a 12% relative increase in stroke prevalence in the working-aged (18–65 years) population of Ontario. Studies have shown that successful community reintegration is an important indicator of perceived quality of life post-stroke.</p> <p>The purpose of this interpretive phenomenological study was to explore the lived experience of community reintegration for working-aged persons post-stroke in order to inform the development of appropriate and effective strategies to support their community reintegration and continued stroke recovery.</p> <p>The essence of the phenomenon of community reintegration for working-aged persons post-stroke emerged as: “Life Goes On: The journey of surviving a stroke in the prime of your life”. Six themes emerged to support this journey of community reintegration after stroke: 1) processing the shock, 2) starting the road to recovery, 3) living with stroke, 4) who am I? 5) carrying-on and 6) transcending the stroke. While participants experienced their personal journey to community reintegration in a unique way, their journey led them to realize that in order to successfully reintegrate back into their community, they needed to adjust, adapt and reach some level of acceptance in order to move on and essentially transcend their stroke</p> <p>There needs to be a call to action for the delivery of client-centered stroke care. A client centered approach to stroke care will ensure that the voices of working-aged persons post-stroke are heard and given priority in their rehabilitation and community reintegration planning.</p> / Master of Science Rehabilitation Science (MSc)

Philosophiae Doctor - PhD / Given the devastating and debilitating impact of spinal cord injuries (SCI) globally and the effects on any population, its impact extends far beyond just the victim to people and institutions surrounding them and supporting them post-injury. Of growing concern is the increased risk that individuals with SCI have been seen to have a three-fold greater risk of developing cardio-vascular disease (CVD) than their able-bodied counterparts. Prevention strategies to curtail the onset of CVD in the SCI population is limited, and often developed for individuals from developed countries. The overall aim of this study was to assess and explore the need to implement CVD prevention programmes in a regional South African population with individuals after sustaining a traumatic spinal cord injury (TSCI). The study employed a mixed methods approach and was conducted in four (4) phases. Permission and ethics clearance were obtained from the Research Ethics Committee at the University of the Western Cape (UWC) and the Western Cape Department of Health. Phase One of the study utilized a questionnaire to collect TSCI incidence data of which 108 of the eligible 132 cases consented to take part in the study. The demographic findings of this study indicated that a person sustaining a TSCI in the Cape Metropolitan area in South Africa is most likely to be a male, young (20 to 29 years of age), from a Black African or Coloured race group and living in the Cape Flats suburbs. The male to female ratio was 6.2:1. The main cause of TSCI was assault at 58.33% (n=63) with males accounting for the majority of cases (88.89%, n=65). According to the AIS classification, ASIA A and D were the most common classification seen in 38.89% (n=42) and 39.81% (n=43) of the cohort respectively. Phase Two utilized a questionnaire and looked at CVD risk factors of the original cohort. A large portion of the cohort was engaged in high-risk behaviours, i.e. smoking and alcohol consumption. A low number of individuals reported a baseline history of hypertension diagnosis prior to their TSCI (5.56%, n=6). Phase Three of the study emplored semi-structured interviews and a focus group discussion to explore the experiences of persons with a TSCI regarding their ability to be physically active once reintegrated back into the community. Despite understanding the associated benefits of physical activity, several barriers to being physically active were reported; factors within their homes, access within their community, and transportation. The present study’s findings illustrated a growing concern among the SCI population for increased risk for developing CVD due to decreased physical activity. Phase Four of the study utilised a scoping review to identify CVD prevention programmes for individuals with a TSCI. Physical activity has been shown to have numerous health benefits of which reducing the risk of CVD is one. Engaging in physical activity, whether it be structured, unstructred or through a sporting activity can play a major role in combating the onset of CVD. Other tools used in reducing the onset of CVD were seen to be self-management strategies of which contrayer views were seen both for and against their use. Conclusion: Better education during the rehabilitation phase might be a key component to individuals with TSCI injury making more informed decisions about prioritising physical activity as they attempt to reintegrate back into their respective communities. The removal of socio-environmental barriers could allow motivated TSCI individuals better access to choosing how to increase their physical activity levels.

A civil-military divide exists within the United States and is perpetuated by a distinct lack of communication between the civilian and military sectors within the population. The purpose of this correlational study was to examine whether attitudes and behaviors of combat veterans affect their positive reintegration into civilian communities. Binder’s social ecology theory provided the framework for the study. Data were collected from 255 combat veterans who responded to a survey. Results were analyzed using a hierarchical multiple linear regression model to determine the influence of military job satisfaction, post-deployment stressors, post-deployment support, and civic engagement on community reintegration efforts, while controlling for age, branch of military service, place of residence, political party affiliation, education, rank, reason for ending military service, and sex. There were statistically significant results that indicate prediction for successful community reintegration may be dependent upon the identification of key associations, including post-deployment support, education, rank, and the reason an individual transitioned out of military service. Findings may also provide policymakers with information about the community reintegration process, which may be used to improve reintegration efforts of combat veterans transitioning back to civilian life for positive social change.

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The current best practices of user-centered design (UCD) may not be optimal with respect to eliciting information from representative users from special populations. This research extended elicitation approaches traditional focus on user needs and context to include criteria describing obstacles users encounter. Military veterans were selected for this research effort as representative users for a use case in technology design that addresses the difficulties associated with community reintegration. This work provides several contributions to the UCD field. First, different elicitation methods were compared by the depth and breadth of design space criteria elicited. Guidelines were generated for designer use of phenomenology in practice. Obstacles were added as an important facet of design, with corresponding grammar rules for construction. Finally, an algorithm was applied as a method for generating personas. Additionally, this dissertation contributes to the field of veteran research. Some example contributions include a set of design space criteria for designers to consider when designing for veterans, and two veteran personas grounded in data procured from the analysis. This research effort was conducted in three phases: elicitation, first-cycle analysis, and second-cycle analysis. The elicitation process engaged 40 military veterans to complete an interview session and a design session. These sessions explored the lived experience of veterans as they reintegrate into communities, and gathered their ideas for technology to assist with veteran reintegration. The researchers who conducted first-cycle coding focused on categorizing the most important participant statements (meaning units) using a codebook. This analysis resulted in over 3,000 meaning units. Additionally, the meaning unit corpus was subjected to systematic second-cycle analyses, using standardized linguistic structures to generate design space criteria. In total, over 6,000 design space criteria were discovered, and these criteria were synthesized to create personas using a situated data mining (SDM) algorithm. Results suggest that the interview session was crucial to elicit higher quantity and broader coverage of design space criteria. It is recommended that designers conduct and analyze interviews that focus on understanding the lived experience of users (not on their technology ideas) as part of a UCD approach. / Ph. D. / User-centered design (UCD) is a design philosophy that emphasizes the needs and other considerations of the end user of a technology when creating that technology. Current UCD practices may not be optimal with respect to obtaining information from representative users from special populations. This research extended elicitation approaches traditional focus on user needs and context to include criteria describing obstacles users encounter. Military veterans were selected for this research effort as representative users for a use case in technology design that addresses the difficulties associated with adjusting to civilian life after service and reintegrating into the civilian community. This work provides several contributions to the UCD field. First, different elicitation methods were compared by the depth and breadth of design space criteria elicited. Guidelines were generated for designer use of phenomenology (study of the lived experience of a population with a phenomenon) in practice. Obstacles were added as an important facet of design, with corresponding grammar rules for construction. Finally, an algorithm was applied as a method for generating personas, which are user profiles created to help designers understand their users. Additionally, this dissertation contributes to the field of veteran research. Some example contributions include a set of design space criteria for designers to consider when designing for veterans, and two veteran personas grounded in data procured from the analysis. This research effort was conducted in three phases: elicitation, first-cycle analysis, and second-cycle analysis. The elicitation process engaged 40 military veterans to complete an interview session and a design session. These sessions explored the lived experience of veterans as they reintegrate into communities, and gathered their ideas for technology to assist with veteran reintegration. The researchers who conducted first-cycle coding focused on categorizing the most important participant statements (meaning units) using a codebook. This analysis resulted in over 3,000 meaning units. Additionally, each meaning unit was examined in second-cycle coding. Standardized linguistic structures and syntax were applied to generate design space criteria. In total, over 6,000 design space criteria were discovered, and these criteria were synthesized to create personas using a situated data mining (SDM) algorithm. Results suggest that the interview session was crucial to elicit higher quantity and broader coverage of design space criteria. It is recommended that designers conduct and analyze interviews that focus on understanding the lived experience of users (not on their technology ideas) as part of a UCD approach.