"All of a sudden, everything changed": a comparative qualitative study about returning home after a spinal cord injury in Norway and Malawi.

PURPOSE: The purpose of this study was to gain knowledge about the transition phase from hospital to home during rehabilitation following a spinal cord injury (SCI) and explore similarities and differences between a high- and a low-income setting.

MATERIALS AND

METHODS

The design of this study was qualitative with data collection in Norway and Malawi. Data were primarily collected through semi-structured interviews, supplemented with observations and field notes.

RESULTS

Seven themes were identified: (1) Confronting change in different ways when returning home, (2) the fragile balance of hope and acceptance, (3) inaccessibility leading to isolation, (4) losing and reclaiming independence, (5) being taken care of by complex services-or left on one's own, (6) social support in the transition, and (7) redefining identity through growth and adaptation.

CONCLUSIONS

The transition from hospital to home following a SCI was described as an extreme life change in both settings. Several factors influenced the transition in both similar and different ways across the contexts, such as availability of health- and welfare services, level of independence, social support, mindset, and the degree of accessibility in the communities. These factors should be considered in the policymaking and rehabilitation interventions for individuals with SCIs.