From theory to practice example: How programs can more intentionally support living well with spinal cord injury

Abstract

This thesis investigates how services can be intentionally designed to support well-being outcomes for people with SCI, a population for whom achieving a meaningful and satisfying life may require support beyond initial rehabilitation.

Methods

A multi-phase qualitative design was employed: phase one comprised a systematic and scoping review, and phase two involved an in-depth qualitative case study of a community-based program. Data were collected through interviews with multiple participant groups, observations, and document analysis. An inductive analytic approach was combined with a theory of change framework to examine how program design and delivery contributed to outcomes.

Findings

The reviews identified a well-developed understanding of factors influencing well-being, but limited insight into how programs actively address these factors in practice. The case study demonstrated that a program structured around a clear well-being aim and an integrated model of service delivery can generate outcomes across multiple domains of well-being. Outcomes were achieved through interrelated mechanisms, including accessible and appealing program entry points, integration of supports that facilitate both immediate positive experiences and longer-term capacity building, and embedded opportunities for informal peer interaction and support. Repeat engagement and the development of a sense of community further amplified these effects. Together, these mechanisms contributed both directly to well-being and to a more positive and expansive outlook on life.

Conclusion

This thesis demonstrates the potential of programs intentionally designed to impact well-being and provides transferable insights into how such outcomes can be achieved in practice. The findings support a shift towards holistic, explicitly articulated well-being aims in rehabilitation and disability services and offer a framework to inform program design, implementation, and evaluation.