Table 2 Summary of CFIR domain-Specific Reflective Statements Informing Actionable Findings

I. Innovation

Adaptability (D)

The innovation can be modified, tailored, or refined to fit local context or needs.

Self-management was acknowledged as demanding and the SCI-HMT had to balance complexity with accessibility. Contact with healthcare for a person with SCI can be challenging. The SCI-HMT has the potential to facilitate improved communication with healthcare services.

The content of the SCI-HMT needs to mix expert clinical information with lived experience knowledge. The digitalized tool will aim to reduce the points of contact to save time and improves efficiency of communication and decision-making for people with SCI and their health care providers. Age does not necessarily present an e-literacy barrier.

II. Outer Setting

Partnerships & Connections (D)

The Inner Setting is networked with external entities, including referral networks, academic affiliations, and professional organization networks.

Participants suggested that knowledge is power and that the SCI-HMT would have strong utility in post-acute rehabilitation services, as well as in primary care setting. SCI peer support networks were considered crucial to promoting the SCI-HMT. Champions from both SCI and primary health communities are needed to facilitate the tool’s integration and utilization.

The SCI-HMT should be promoted for use at all time points from post-acute rehabilitation onwards, and be circulated through SCI community groups, as well as primary and tertiary care centers to maximize uptake.

Collaboration with College of GPs is recommended for recognition of the value of the six modules for CPD credentials.

III. Inner Setting

Recipient-Centeredness (D2)

There are shared values, beliefs, and norms around caring, supporting, and addressing the needs and welfare of recipients.

Self-management of health and well-being is substantial and could potentially be resisted by people with SCI if they felt overwhelmed. While GP’s are time poor, support by GPs for self-management was considered essential. The SCI-HMT can help to synthesize self-reported symptoms, behaviours or observations.

Productive partnership between GPs and people with SCI can benefit from digital diaries for each module with links to the creation of a care plan to enhance sharing of information. This can improve the potential to pick up on any red flags before a crisis. It was recommended that this care plan is linked to annual review on/or about anniversary of onset of SCI.

IV. Individuals

Innovation Recipients (I)

Individuals who are directly or indirectly receiving the innovation.

The SCI-HMT can help people with SCI to remain healthy and see a brighter future. However, a person with SCI may be overwhelmed by the scale of SCI-HMT content and the requirement for lifelong vigilance. Inclusion of appropriate information addressing the ‘long game’ of SCI is necessary.

The inclusion of lived experience quotes regarding how to self-manage the ‘long game’ for optimal health promotion after SCI is essential. It is recognised that simply “being told what to do” is not helpful.

V. Process

Innovation Recipients (B2)

Collect information about the priorities, preferences, and needs of recipients to guide implementation and delivery of the innovation.

Four areas for future iterations of the SCI-HMT were identified: (i) sexuality (ii) the taboo nature of bladder and bowel topics for indigenous people, (iii) for SCI-HMT care plans to be compatible with patient management systems, and (iv) leisure as a standalone topic especially the notion of fun.

To ensure longevity, ongoing evaluation of the SCI-HMT by people with SCI, SCI community groups, funders, policy makers and health services is essential to monitor appropriateness of content and identify important gaps which may emerge over time. The digital SCI-HMT can provide regular evidence-based practice updates, with inclusion of links and clinical guidelines, will be far easier to do with a web-based tool/app.