A Meta-synthesis of Individual, Interpersonal, and Systemic Factors Impacting Resilience after Traumatic Brain Injury

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