The meaning of employment from the perspective of persons with spinal cord injuries in six European countries.

BACKGROUND: People with spinal cord injuries (SCI) are underrepresented in the labour force. OBJECTIVE: To examine the meaning of employment, as it is understood in the context of participation and integration in society, among persons with SCI in six European countries. We ask how SCI relates to employment, for the functions of employment, alternatives to employment, and its obstacles. METHOD: Semi-structured interviews were conducted with 74 persons and qualitatively analysed using a grounded theory approach. RESULTS: Employment was ranked as very important independent of the participants current employment status. We identified three main functions of employment: 1) employment contributes to the creation of personal and collective identity and social recognition; 2) employment enables structuring of time and distracts from impairment and pain; 3) employment is as an important social arena that facilitates interaction with other people. Voluntary work and domestic work did not fully replace the social functions of employment, nor correspond to the design of the disability compensation systems. CONCLUSION: This study illustrates the high value of employment and a need to pay more attention to a broader range of productive work. It also reveals the interdependencies between employment status and income mediated by the disability compensation schemes.

Participation and integration from the perspective of persons with spinal cord injury from five European countries.

OBJECTIVE: To examine the subjective understanding of participation and integration of persons with spinal cord injuries from 5 European countries and to compare these findings with the International Classification of Functioning, Disability and Health (ICF)'s conceptualization of participation. METHODS: Semi-structured interviews with 54 persons with acquired spinal cord injuries and 3 with spina bifida from 5 countries were examined using qualitative content analysis. RESULTS: Integration was most often associated with social acceptance and, furthermore, with ordinary performance, equality and freedom of choice. Participation was most often described as ordinary performance, with less emphasis on social acceptance and equality. However, participation and integration overlapped in people's narratives and were difficult to separate. The perception of participation and integration was largely similar across countries. In contrast to others, however, Finnish interviewees were more likely to associate participation with contributing to society. A variety of life domains was identified, of which recreation and leisure, work life, sports and going out were the most prevalent. CONCLUSION: While participation domains are well covered by the ICF, as is the notion of ordinary performance, interviewees also referred to a rights (e.g. acceptance) and duties (e.g. contribution) perspective.