Factors Affecting Employment Following Spinal Cord Injury: A Qualitative Study

ABSTRACT. Objective: To examine factors that differentiated persons with spinal cord injury (SCI) who returned to work from those who did not. Participants: Six employed persons with SCI matched with 6 unemployed persons with SCI on the basis of education, race, age, gender, time since injury, and level of function. Study Design: Semi-structured interviews 1 to 2 hr in length were completed and transcribed. The responses of the employed were compared with those of the unemployed using grounded theory. The theory is inductively derived from the qualitative data. Results: Psychological and environmental factors were the most salient factors affecting employment in this matched sample. Key psychological factors associated with employment were optimism, self-esteem, achievement orientation, and role models. Key environmental factors were monetary incentives, disincentives, access, and accommodation. Conclusions: The development of increased optimism may promote employment for persons with SCI. Employment barriers and the perception of these barriers as insurmountable need to be decreased. Policies that promote return to work with former employers are likely to improve employment rates for persons with SCI. A more intensive job exploration process using job shadowing of peers and positive peer models may also improve employment after SCI.