Date of Award

Spring 5-15-2026

Degree Type

Dissertation

Degree Name

PhD Health Sciences

Department

Health and Medical Sciences

Advisor

Genevieve Zipp, P.T., Ed.D., FNAP

Committee Member

Michelle Lee D'Abundo, Ph.D

Committee Member

Denise Fyffe

Keywords

Spinal Cord Injuries, Community-Based Rehabilitation, Mixed Methods Research, Social Cognitive Theory, Transition to Adulthood

Abstract

Young adults with spinal cord injury (SCI) face significant challenges during the transition to adulthood, including barriers to independence, community participation, and psychosocial adjustment (Ingimarsdóttir et al., 2023; Zebracki et al., 2010). Current rehabilitation models in the United States prioritize short-term physical recovery and offer limited support for the developmental and contextual needs that shape long-term outcomes after SCI, particularly during transitions from inpatient rehabilitation to the community (Anderson et al., 2024; Bryden & Gran, 2024). Community-based programs may help address these gaps, though few have been rigorously evaluated using implementation science frameworks that attend to health equity, contextual influences, and sustainability (Barclay et al., 2020; Fort et al., 2023). The purpose of this mixed methods study was to evaluate the reach, effectiveness, and implementation of the 2025 True Grit SCI residential program, a community-based, week-long residential intervention designed to support transition-age youth (16-21) with SCI. Guided by Social Cognitive Theory (Bandura, 2004) and informed by the RE-AIM and PRISM frameworks (Glasgow et al., 2022; McCreight et al., 2019), this multi-phase mixed methods program evaluation examined outcomes and implementation from multiple interest holder perspectives, including young adults with SCI, family care partners, and program staff. Reach findings highlighted the heterogeneity of participants’ demographic, injury-related, and health-related social needs. Quantitative findings demonstrated improvements in goal attainment and functional independence following program participation, while changes in resilience scores were not statistically significant. Qualitative findings, however, revealed perceived gains in confidence, self-efficacy, coping, and readiness to engage in daily life and community activities. Peer mentorship, goal-directed practice, and immersive residential experiences emerged as mechanisms supporting these outcomes, alongside implementation strengths and areas for refinement relevant to sustainability and equitable scalability.

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