Impact of Photovoice on Fall-related Psychological Variables, Participation Levels and Quality of Life in Chronic Spinal Cord Injury

Research Objectives: To investigate the effects of a photovoice intervention on falls self-efficacy and concern about falling in individuals with chronic spinal cord injury (SCI). Secondary objectives included examining the effects of a photovoice intervention on participation levels and quality of life in individuals with chronic SCI. We hypothesized that following photovoice, falls self-efficacy, participation and quality of life would improve, while concern about falling would decrease.

Design: Convergent mixed methods design. A pre-post design was used for the quantitative strand, with questionnaires administered pre-intervention, immediately post-intervention and three months post-intervention. A qualitative descriptive design was used for the qualitative strand, with semi-structured interviews occurring three months post-intervention. Integration occurred at the level of data analysis/interpretation.

Setting: Virtual, community setting in Canada and the US.

Participants: Volunteer sample of 34 adults with chronic SCI. Seventeen participants used a wheelchair (13 men, 4 women, aged 49.0±11.5 years) and 17 participants ambulated (6 men, 11 women, aged 63.6±10.5 years).

Interventions: The six-week photovoice intervention involved two photo-assignments, two individual interviews with a peer mentor and researcher, and four group meetings (8-9 participants/group, grouped by mobility status). Participants used photographs and dialogue to identify and share strategies they used to prevent falling.

Main Outcome Measures: The primary outcome measures were the Activities-specific Balance Confidence Scale and Falls Efficacy Scale-International for participants who ambulated, and the Wheelchair Use Confidence Scale and Spinal Cord Injury Falls Concern Scale for those who used a wheelchair. Secondary measures included the Impact on Participation and Autonomy Questionnaire and Life Satisfaction Questionnaire-9. Scores were compared over time using a repeated measures ANOVA or Friedman’s test. Qualitative data were analyzed using a reflexive thematic analysis. Quantitative and qualitative data were merged via joint display.

Results: There were no changes in the primary measures over time for both groups (p≥0.109). Participation scores were significantly greater three months post-intervention in the ambulatory group (p≤0.028). There were no significant changes over time in other secondary measures (p≥0.120). Concordant findings were observed between the quantitative and qualitative data. Although some participants stated their falls self-efficacy and participation improved, others did not. Participants indicated the intervention lacked relevancy in chronic SCI; they have “been through almost every scenario possible” and know how to manage their fall risk.

Conclusions: Ambulatory individuals with chronic SCI showed increased participation levels after a photovoice intervention, but no change in falls self-efficacy, concern about falling or quality of life. Photovoice did not impact the outcomes of wheelchair users with SCI.

Author(s) Disclosures: None.