Endorsement of barriers and facilitators to employment after spinal cord injury: Race, ethnic, and gender-based differences

Research Objectives: 1) To compare the endorsement of self-reported barriers and facilitators to employment between racial and ethnic groups and gender following spinal cord injury.

2) To propose recommendations that address barriers and enhance facilitators to increase employment after spinal cord injury for marginalized racial, ethnic, and gender groups.

Design: Cross-sectional study using self-report assessments obtained by mail or online.

Setting: Medical university in Southeastern region of the United States.

Participants: Participants (n=1,621) from specialty hospitals and a population-based surveillance system diagnosed with traumatic SCI, 1 year post-injury, and between ages of 18 and 64.

Interventions: Not applicable.

Main Outcome Measures: Self-reported assessment for barriers and facilitators to employment.

Results: Overall, African Americans with SCI compared to non-Hispanic Whites and other racial/ethnic groups reported more barriers to employment related to education, training, resources, health status, finances, attendant care, knowledge of appropriate jobs, family support to work, transportation, and their confidence level. Additionally, they perceive that most employers will not hire them because of their disability. Despite injury, however, results that can facilitate work for the same group is they feel work is more important than other activities, they are motivated to work, and they are physically capable to work compared to counterparts. Results for females vs. males related to barriers are the accessibility of jobs, needing attendant care, feeling most employers will not hire because of disability, and loss of financial benefits; whereas, males reported barriers of children at home. Facilitators for the same group are more physically capable of working compared to their male counterparts.

Conclusions: African Americans and females with SCI identified multiple barriers compared to non-minority and male counterparts, respectively. These barriers are mostly modifiable and can be addressed with targeted client and family education, disability training, resource allocation, and motivational interviewing. The non-modifiable barriers will require the engagement of health professionals and policymakers to address overall health beyond injury and environmental needs. Detailed recommendations for marginalized groups are forthcoming.

Author(s) Disclosures: Authors have no conflicts of interest to disclose.