Psychosocial factors represent complex and enduring challenges for people with a traumatic brain injury (TBI), their families and health and rehabilitation systems, particularly in relation to social isolation, change/loss of role and identity issues. Traditional rehabilitation approaches to psychosocial issues target cognitive rehabilitation and psychological adjustment of the individual with a TBI, which reflect the medical model of health. However, the International Classification of Functioning, Disability and Health (ICF) ushers a new era in TBI research and practice, which advances the conceptualisation of disability, to include the impact of environmental factors. The ICF identifies the Internet as one such environmental factor, which has the potential to facilitate or impede social participation of people with a disability. Empirical studies suggest the potential of the Internet to empower people with disabilities, via opportunities for social connection; social support; social role participation and identity experimentation. However, research has focused on people with sensory, physical, and mental health issues, with little known of the potential of the Internet for people with a TBI. This area of deficit warrants investigation, in view of the potential of the Internet to address many dimensions of psychosocial concern following TBI. This study explores the role of the Internet in the lives of people with a TBI, with a focus on the potential of the Internet to influence psychosocial recovery. Psychosocial recovery is conceptualised as the reconstruction of a positive identity, as found in subjective accounts of people with a TBI (Lewington, 1996), and strongly supported in the mental health consumer literature. Using a social constructionist approach, this study explores how people with a TBI use the Internet and how they make meaning of their Internet experience. This approach acknowledges the socially situated nature of Internet use and validates the subjective accounts of people with a TBI, whose perspectives are underrepresented in the rehabilitation literature. This study also trials the method of email-facilitated qualitative interviewing, to address face-to-face interviewing barriers, relating to cognitive-linguistic impairments (Lloyd, Gatherer, & Kalsy, 2006; Paterson & Scott-Findley, 2002). Thus, the Internet is the focus of the enquiry and the mediator of the method. The findings highlight the positive potential of the Internet to facilitate social participation for people with a TBI. Participants reported that features such as asynchronicity, reduced cues and anonymity made the Internet an accessible and usable technology, for social connection; social support; social role participation and identity reconstruction. A major theme emerging from the data was control of self, which this study conceptually linked to identity reconstruction and psychosocial recovery. Findings allayed concerns regarding the negative potential of the Internet to increase social isolation of vulnerable people, as participants regarded face-to-face relationships as more fulfilling than online friendships, supporting classic communication theories (Rice, 1987; Rice & Love, 1987), which propose that the Internet is a less personal medium than face-to-face communication, due to the feature of reduced cues. The findings of the method indicated that email facilitated qualitative interviewing addressed face-to-face interviewing barriers related to cognitive linguistic impairments; mobility factors; chronic health issues and environmental stimuli. Most participants indicated that asynchronicity, reduced cues, and anonymity facilitated control of communication, cognition and identity, thus enabling interview participation. The method had also advantages for the researcher, including time for reflection and the ability to yield richer data than in face-to-face contexts. However, the method was resource intensive, requiring information technology proficiency, familiarly with the impact of cognitive-linguistic impairments in online contexts and counselling experience. In addition, ethical guidelines required the involvement of a support person for the emotional protection of participants. This study makes two contributions to knowledge. One contribution relates to the potential of the Internet as an ICF environmental factor to address long-term psychosocial concerns, in addition to positively influencing psychosocial recovery from TBI, as reported by participants. This study contributes to a new era of research, which considers the impact of environmental factors on the experience of TBI, as framed by the ICF. The second contribution relates to the method of email facilitated qualitative interviewing, which advances knowledge of interviewing barriers for people with a TBI and addresses calls for innovative methods with this population. The findings of the method bring into question long held assumptions about the capacity of people with a TBI to participate in research and have implications for research design in qualitative and quantitative methodologies.
| Identifer | oai:union.ndltd.org:ADTP/285416 |
| Creators | Jennifer Egan |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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