Getting motivated: long-term perspectives on engaging in community-based programs after acquired brain injury

ABSTRACT

Background

Low motivation is a common problem after acquired brain injury (ABI) and can persist for years after injury. Little is known, however, about perspectives of motivation with respect to engaging in the community, many years after ABI.

Purpose

To explore the client with ABI perspective of motivation and engagement in individuals based in community ABI programs.

Method

Interpretive description methods were utilized. Semi-structured interviews were conducted with 21 individuals with an ABI.

Findings

Participants felt that both internal factors, such as feelings of hope, and external factors, such as social support, influence levels of motivation to engage. When positive internal and external motivators were enhanced, and negative internal and external motivators reduced, this gave rise to a sense of choice and control, which led to increased engagement.

Implications

Fostering positive aspects of rehabilitation and increasing choice and control may promote engagement. External motivators, such as reducing repetitiveness and promoting peer support, are motivators that community and clinical settings can implement relatively easily, whilst internal motivators such as attitudes toward therapy may need to be addressed continuously to enhance motivation and engagement.

KEYWORDS:

• Traumatic brain injury
• qualitative
• interpretive description
• community-dwelling

Key messages

• Clinicians can facilitate engagement in ABI community settings by reducing negative external motivators such as repetitiveness of activities and pressure from staff, and increasing positive external motivators such as a sense of routine and peer support by increasing individual participation in group activities and facilitating member to member connections.

• Sustaining long-term engagement may need to focus on increasing positive internal motivators (such as hope and identifying personal goals) and reducing negative internal motivators (such as aversive attitudes toward therapy and relearning essential skills).

• Personalizing programs and services, such as through offering one-to-one support and requesting activity suggestions from clients, may enhance a sense of choice and control, and hence improved engagement.

Acknowledgments

The authors would like to thank Dr. Sandra Moll for her valuable assistance in developing the questions and methodology, as well as the staff and clients at the Hamilton Brain Injury Association and Head Injury Services Ontario (formerly Brain Injury Services of Hamilton) for participating in and providing support of this study.

Conflicts of interest

The authors declare that there is no conflict of interest.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.