Self-Awareness of Deficits and Realistic Goal-Setting Among Black American Males With Traumatic Brain Injury

Background and Purpose: Traumatic brain injury (TBI) is a growing public health concern in the United States, with 3.2 million Americans becoming disabled as a result of the consequences of injury. Blacks and Latinos have the greatest risk of sustaining a TBI in comparison to other racial/ethnic groups. Few studies assess the outcomes and needs of ethnic minorities with TBI, particularly regarding their self-perceived cognitive, emotional and social functioning after injury. Impaired self-awareness of deficits and its effects along with the inability to set realistic goals after injury has been documented in the literature but using non-ethnic minority samples. Understanding self-awareness and goal setting of blacks with TBI may help social workers and rehabilitation professionals better understand how impaired self-awareness may impede such clients’ ability to adhere to treatments and follow-through with referrals of needed services. The author present qualitative data to understand self-awareness of deficits, self-awareness of functional implications of deficits, and the ability to set realistic goals after TBI among black American males with TBI.

Methods: Using a qualitative content analysis approach, the sample consists of 10 medically documented persons with TBI who self-identified as black American and at least three months post injury. A convenience sample of participants from other TBI research studies, recruited based on consecutive admission to a Level 1 trauma center, were recruited for the current study. Quota sampling was employed based of recovery point (less than one-year, 2-5 year, and greater than 5 year post injury). Exclusion criteria included pre-existing neurological, developmental, psychiatric and behavioral disorders; individuals under the age of 18; live outside of a 100-mile recruitment radius from the research center. Subjects participated in an in-depth semi-structured interview regarding their self-awareness of deficits and realistic setting of goals based on The Self Awareness of Deficits Interview (SADI). Interviews took place either in the research center or participant’s home. Data analysis included content analysis for each of the three areas of the SADI using NVivo 8.

Results: The content analysis revealed that many participants reported memory deficits, physical changes, and mood/personality changes after injury. Majority was aware of their cognitive/psychological problems but some placed greater emphasis on the physical changes. While majority expressed that the TBI affected their everyday life, a few minimized the importance of identified problems or did not identify any problems. There was a mixture of responses regarding goal setting, where some were able to set realistic goals while others either set unrealistic goals or could not identify any specific goals for themselves. Individuals who were less than one year post injury reported greater impaired self-awareness based on the SADI.

Conclusions and Implications: Individuals early in their recovery may lack self-awareness of deficits and have the inability to set realistic goals after injury. This study provides insight into self-perceived recovery of black American males with TBI to help social workers and rehabilitation professionals consider such impairments when making treatment recommendations to improve their access to services and quality of life after injury.