Occupational Identity and Competence of Women with Spinal Cord Injury following Rehabilitation

Abstract

Background: Spinal cord injury (SCI) profoundly affects individuals physical, psychological, and social functioning, often compounded by gendered expectations and societal roles. Rehabilitation is a critical process for regaining functional abilities, adapting to bodily changes, and re-engaging in meaningful occupations. However, SCI frequently disrupts occupational identity (one’s sense of self through meaningful activities) and occupational competence (the ability to sustain participation consistent with that identity). Women may face difficulties reclaiming pre-injury roles, achieving autonomy, and participating in valued occupations, alongside barriers such as inaccessibility, stigma, limited resources, and insufficient long-term support. Using narrative inquiry to explore the lived experiences of women with SCI offers deeper insight into how they reconstruct identity, rebuild competence, and redefine their lives following rehabilitation. Aim: Exploring and understanding the occupational identity and perceived occupational competence of women with spinal cord injury (SCI) following rehabilitation, and to examine perceived factors that shape their participation in daily life and community. Methods: The narrative enquiry approach of qualitative research design was chosen for this study. Purposive sampling was used including 12 women who were clinically diagnosed with spinal cord injury and had received rehabilitation services at CRP. The data collection process involved face-to-face, in-depth, semi-structured interviews using a self-developed interview guide which was guided by the Occupational Performance History Interview-II (OPHI-II). Thematic narrative analysis was used to analyze the data collected following eight key steps. Result: From the six themes and seventeen sub- themes the findings showed that firstly, women with SCI experienced a profound disruption of their occupational identity and competence following injury, marked by loss of previous roles, independence, and emotional stability. Post-rehabilitation, participants reconstructed their occupational identity by redefining roles related to motherhood, homemaking mostly instead of going back to their previous occupational roles due to lack of support. Occupational competence was rebuilt through task modification, pacing, assistive use, and growing self-efficacy rather than restoration of pre-injury abilities. Family support showed as both enablers and barriers, environmental accessibility, and social attitudes acted as key barriers shaping women’s participation in daily and community life. Conclusion: This study shows that spinal cord injury causes a significant disruption to women’s occupational identity and competence, although rehabilitation plays an important role in supporting recovery, the reconstruction of occupational identity and competence is a gradual and ongoing process rather than a complete restoration. Through rehabilitation many women regained a sense of capability. The findings show that women with SCI often experience a deeper occupational identity crisis due to socio-cultural expectations, environmental barriers, and limited opportunities for participation within the Bangladeshi context. These challenges highlight that physical rehabilitation alone is not sufficient. The study underscores the importance of gender sensitive and contextually relevant rehabilitation approaches that address not only functional recovery but also identity, and long-term participation in meaningful occupations. Keywords: Spinal Cord Injury (SCI), Occupational Identity, Occupational Competence, Rehabilitation, Advocacy.