Intra- and interpersonal agency: Resuming occupational participation among persons with spinal cord injury after discharge from in-patient rehabilitation

Background: This research aim was to understand and describe how changes occur in occupational participation among persons with spinal cord injury (SCI) following discharge from a rehabilitation center in Bangladesh.Materials and methods: Using a selected ethnographical research design, nineteen participants were selected following a purposive sampling technique, then interviewed and observed on three occasions. Data analysis consisted of an iterative approach combining thematic narrative and narrative slopes analyses.Results: Eight themes determined the transitional progress, regression and stability, in which, three of the eight themes characterized the ascending slopes, namely developing affirmative attitudes, adapting the occupational environments and working on identities. Three themes characterized the descending slopes, which were reducing confidence created difficulties, becoming bored in daily life, and declining health reduced social connections. The final two themes characterized periods of stability, namely, maintaining daily life through skills and helplessness to participate in occupations.Conclusions and significance: Each of participants' transitions unfolded in unique, complex patterns. The processes directions of the transitions were understood as waning and waxing of agency. This agency could be individual, and shared with or dedicated by others, when participants and other persons combined their skills or when participants were supported by others.