A RCT of a Psychological Health Promotion Program for Women with SCI:Examining Efficacy and Mechanisms

Abstract

<h3>Research Objectives</h3> To examine the efficacy of a psychological health promotion group intervention for women with SCI and test mechanisms of change. <h3>Design</h3> Two-group (intervention vs. control) by three times of testing (pre, post, follow-up) randomized controlled trial. <h3>Setting</h3> Online virtual world of Second Life (SL). <h3>Participants</h3> A national sample of 175 women with traumatic SCI who were at least one year post-injury. <h3>Interventions</h3> The 10-week group-based Zest intervention was offered in a private parcel of land in SL. Zest participants, represented as avatars, met weekly for 10 weeks. The program featured didactic information, group discussion, action planning, homework activities, and relaxation training. <h3>Main Outcome Measures</h3> We proposed a model in which the effect of the intervention on primary outcomes (Rosenberg Self-esteem Scale, PHQ-8, and Satisfaction with Life Scale) at T3 (6 month follow-up) would be mediated by the effect of the intervention on proximal outcomes (Generalized Self-efficacy Scale, Perceived Stress Scale, MOS Social Support Scale) at T2 (post-test). <h3>Results</h3> Results of analyses with Zest program completers indicated that women in the Zest intervention group demonstrated greater improvements from T1 (baseline) to T2 (post-test) than control group participants on measures of self-efficacy, stress, self-esteem, depression, and life satisfaction with improvements maintained from T2 to T3. Intent-to-treat analyses produced similar findings, although group differences in depression were no longer significant. In testing our mediational model, we found self-efficacy fully mediated the effect of the intervention on self-esteem and life satisfaction, while perceived stress fully mediated the effect of the intervention on depression. <h3>Conclusions</h3> Group psychoeducational programs that specifically target self-efficacy enhancement and stress management hold promise for improving psychological health among women with SCI. <h3>Author(s) Disclosures</h3> None.