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Objective(s)
To offer the first meta-synthesis of factors influencing resilience after TBI using
a Social Ecological model framework.
Data Sources
We performed key word searches in five electronic data bases (Google Scholar, PubMed,
PsycINFO, and EBSCOhost) from inception- June 2021.
Study Selection
We selected studies that met the following criteria: (1) included civilian adults
with history of at least 1 moderate-severe TBI; (2) included information on psychosocial
stressors, coping strategies, and/or resources related to adjustment after TBI; (3)
used qualitative methods; (4) not a systematic review; (5) written in English. Two
reviewers separately screened article titles, abstracts, and texts to select eligible
articles, and resolved disagreements through discussion with the research team.
Data Extraction
We used the 9-item quality appraisal tool developed by Hawker and colleagues to assess
the methodological and reporting quality of all included studies (Hawker, Payne, Kerr,
Hardey, & Powell, 2002).Two members of the team independently reviewed each full-text
article and extracted findings. We then inserted extracted findings into a standardized
form for all articles.
Data Synthesis
We chose to adopt meta-synthesis framework to data analysis to integrate findings
across studies and produce novel interpretations of the data (Walsh & Downe, 2005).
We performed a taxonomic analysis on our a-priori determined themes of interest. We
extracted findings into 2 taxonomies—one for barriers of resilience and another for
facilitators of resilience, consistent with empirical models of resilience following
TBI. We utilized a Social Ecological Model (Fleury & Lee, 2006; Partelow, 2018) framework
to organize findings within each taxonomy into individual, interpersonal, and systemic
levels.
Conclusions
We synthesized findings using a Social Ecological Model framework to guide thematic
analysis. Persons with TBI identified barriers and facilitators to resilience at individual
(e.g., physical and cognitive challenges, coping behaviors), interpersonal, (e.g.,
stigma and isolation) and systemic (e.g., access to resources, rehabilitation support)
levels. Considering multifaceted factors at individual, interpersonal and systemic
levels in clinical, research, and policy-setting contexts is important for cultivating
resilience and optimizing recovery after TBI.
Author(s) Disclosures
We have no conflicts of interest to disclose.
Key Words
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Copyright
© 2022 Published by Elsevier Inc.
