Implementing psychosocial guidelines into specialized spinal cord injury rehabilitation services to strengthen person-centred health care: protocol for a mixed methods study

Candice McBain ^1,2* Anne Marie Sarandrea ^2,3,4 Ilaria Pozzato ^1,2 Mohit Arora ^1,2 Daniel Myles ^1,2 John Bourke ^1,2 Yvonne Tran ⁵ Ian D Cameron ^1,2 James Middleton ^1,2,4 Ashley Craig ^1,2

• ¹ John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
• ² Kolling Institute of Medical Research, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
• ³ Spinal Cord Injury Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Sydney, NSW 2065, Australia
• ⁴ State Spinal Cord Injury Service, Agency for Clinical Innovation, St Leonards, Sydney, Australia
• ⁵ Macquarie University Hearing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia

Background: Spinal cord injury (SCI) is a severe neurological disorder resulting in loss of movement and altered sensation with lifelong impacts on health, function, and social integration. Multidisciplinary SCI rehabilitation primarily focuses on enhancing function and independence while simultaneously managing secondary health conditions and providing psychosocial support. Therefore, a major goal in SCI rehabilitation should be strengthening patients' capacity to cope with and adjust to challenges they encounter. Using a mixed methods design, the primary aim of this study is to integrate psychosocial guidelines that promote psychological adjustment into SCI rehabilitation, and second, to evaluate facilitators and barriers to their successful implementation.To determine perceived depth of knowledge, beliefs, and attitudes about psychosocial care, and usage of psychosocial guidelines, healthcare workers in the three specialist SCI services in New South Wales, Australia will be invited to complete a baseline survey. Following the survey, semi-structured one-to-one interviews and focus groups will be conducted with health professionals representing different health disciplines to understand the context and generate ideas about how best to integrate these guidelines into clinical practice.Based on the surveys, interviews, and focus groups, an implementation intervention employing educational strategies, structural, and nudge (behavioural change) approaches will be designed and implemented over a period of 18-months to facilitate integration of the guidelines into the SCI services. A post-intervention survey with healthcare workers will then be conducted. Focus groups from each Unit, with representation across the different health professions, will also be conducted to identify facilitators and barriers to implementing the guidelines. Success of implementation will be determined by analyzing any shifts in perceived knowledge, attitudes, and behaviour of staff and cultural/structural processes observed through comparing baseline and post-intervention qualitative and quantitative data.To capture lived experience insight, 15 people with SCI currently undergoing rehabilitation will be interviewed.Discussion: This study will establish the success of implementing psychosocial guidelines into three specialist SCI services. It is hypothesized that constructive changes will occur in the knowledge, attitudes, and behaviour of the SCI Unit health professionals, leading to improved psychosocial practices and patient outcomes that will strengthen person-centred healthcare in SCI rehabilitation.