Self-management decision-making in spinal cord injury after initial rehabilitation: A thematic narrative analysis

This study examines how individuals with spinal cord injury (SCI) make decisions regarding their self-management (SM) in the first six months after initial rehabilitation. Specifically, it explores the decision-making styles and the factors that influence their choices.

We conducted semi-structured interviews with 32 individuals with SCI at three- and six-months post-discharge, resulting in 64 interviews. Data collection spanned from November 2022 to August 2024. We used thematic analysis to identify the decision-making styles and their influencing factors.

Our findings reveal that individuals do not rely on a single, stable decision-making style but instead adapt their ways based on the demands of a given situation. Five distinct decision-making styles emerged: 1) Delayed decision-making: postponing action until necessary, often due to emotional barriers or perceived low urgency; 2) collaborative decision-making: seeking input from healthcare professionals, family, or peers to reduce uncertainty; 3) reflexive decision-making: relying on internal cues and body feedback without pre-planning and past experience to guide SM choices; 4) impulsive decision-making: making quick, spontaneous decisions based on immediate emotions or circumstances; and 5) strategic decision-making: planning, testing, and use of external tools to optimize outcomes. Participants shifted between styles based on the context, suggesting that decision-making is not a fixed trait but a dynamic process.

Decision-making in SCI varies across situations, influenced by personal, emotional, and external factors. Unlike traditional decision-making models, these findings highlight that individuals adapt their ways rather than relying on a single decision-making style.

Understanding how individuals make SM decisions can help healthcare providers tailor interventions. Personalized strategies, such as behavioral activation for delayed decision-makers or decision aids for strategic thinkers, may enhance engagement, adherence, and long-term SM success. Future research should explore longitudinal shifts in decision-making styles and their impact on health outcomes.