Abstract
Objective
To describe the financial capability (FC) and financial well-being (FWB) of adults living with acquired brain injury (ABI) from a lived experience perspective.
Design
People living with ABI completed a 32-item and close others a 22-item anonymous survey using either online or print/mail-in options.
Setting
Responses were collected from adults in the province of Manitoba (Canada) during August-October 2021.
Participants
Respondents were adults (18+) living with ABI (n=38) or close others of ABI survivors (n=19). Adults living with ABI experienced traumatic brain injury (n=22; 58%), stroke (n=8; 21%), or other ABI mechanisms (n=8; 21%). Nineteen (50%) respondents with ABI were men, 17 (45%) were women, and 1 (2.5%) was nonbinary; 95% were more than 1-year post-ABI. Close others were spouses/partners, parents, other family, and paid caregivers. Three of the 19 close others self-reported as men and 16 as women.
Interventions
n/a.
Main Outcome Measure(s)
n/a.
Results
For key FC indicators, 13 (34%) people living with ABI felt their current knowledge and skills were insufficient, and 26 (70%) felt that ABI had affected their ability to make financial decisions or complete financial activities. Fourteen of the 19 close others have worried about the finance-related choices, skills, or behaviors of the person living with ABI, and 17 felt that ABI symptoms had affected the FC of the person living with ABI. For key FWB indicators, 22 (58%) adults living with ABI felt stressed or anxious about finances at least some of the time. Seventeen (45%) of the adults living with ABI reported having trouble making ends meet at least some of the time.
Conclusions
Respondents reported FC limitations and FWB challenges for people living with ABI, which can be indicative of financial vulnerabilities and unmet needs. Future research should explore optimal ways to address these financial-related challenges after ABI.
KEYWORDS: Brain injuries, Economics, Financial management, Financial stress, Rehabilitation, Socioeconomic factors, Stroke, Surveys and questionnaires
For people living with acquired brain injury (ABI), whether by stroke, traumatic brain injury (TBI), and other non-TBI mechanisms, financial or economic challenges, including financial capability (FC) limitations and reductions in financial well-being (FWB), are one of the largest unmet needs and foremost concerns after ABI.1, 2, 3 However, there is a dearth of published literature that examines the FC and FWB of adults living with ABI. The purpose of our study was to describe FC and FWB experiences and identify potential challenges and directions to address FC and FWB for adults living with ABI.
Economic life, including FC activities and participation and FWB outcomes, is a major life area.4 Using evidence-based definitions and frameworks from the areas of finance and economics, FC is the knowledge, skills, attitudes/confidence, and applied behaviors related to managing money, accessing financial resources, planning and making choices related to finances, and securing financial-related help when needed.5,6 FWB is a larger concept that encompasses FC, where FWB is the subjective or objective outcomes of financial- or economic-related behaviors and activities within a socioeconomic context and influenced by other physical, sensory, and technological environmental factors.6,7 Many people experience financial challenges, regardless of ABI status, and in general population studies reductions in FWB are associated with declines in cognitive functions, social relationship quality, mental and physical health, and general well-being.8, 9, 10, 11
The concepts of FC and FWB are even more pertinent to the lives and outcomes of people living with ABI, who can experience additional FC and FWB challenges after ABI.3,12,13 For example, between 23% and 34% of adults living with ABI self-report issues related to managing money.12,14,15 Also, evidence from laboratory or clinical studies using varied standardized measures related to FC demonstrate financial knowledge and skills challenges in the acute and chronic stages after ABI, with challenges persisting past 6 months after ABI in complex financial activities that require more planning or executive functions.16, 17, 18
Studies also demonstrate threats to FWB after ABI. Many people with ABI experience a downward shift in economic status and declining income over time.19,20 Low income, a socioeconomic indicator contributing to reduced FWB, is much greater for those who experience disability; those who experience cogntive or mental disability, which is experienced by a significant proportion of brain injury survivors,21 have the greatest rates of low income compared with other disability types.22,23 Further, there is increasing evidence for high incidence rates of ABI in those experiencing homelessness or precarious housing.24,25 Concerningly, declines in or lower FWB after ABI are associated with threats to goal-attainment, recovery, stability in social relationships, community and social participation, health, and general well-being after ABI.2,13,26, 27, 28, 29, 30
Yet, limited published literature has specifically examined in-depth the FC and FWB experiences and realities of people living with ABI. We could find no past survey studies specifically focused on the finance or economic issues related to living with ABI. Further, past studies have had different wording and possible interpretations to their finance- or economic-related items that were part of broader topic surveys (eg, unmet needs12, 13, 14, 15), with limited interpretation application of the item to FC vs FWB concepts. Both the lack of understanding of real-world experiences and the entanglement of specific issues related to FC vs FWB pose obstacles to understanding and addressing the financial challenges after ABI.
Hence, the purpose of our study was to examine the FC and FWB of adults living with ABI. The objectives were to describe the FC and FWB experiences and related possible financial education needs of adults living with ABI from the perspective of people with lived experience.
Methods
Design, setting, and participants
We completed cross-sectional surveys of 2 groups: adults living with ABI and close others of someone living with ABI. All participants were 18 years or older at the time of the survey and currently living in the province of Manitoba (Canada). Respondents with ABI self-identified themselves as living with an ABI. Close other respondents self-identified as a family, involved friend, or caregiver who has provided or currently provides care or support for a person living with ABI. As these were anonymous surveys, we were not able to determine whether any ABI-survivor respondents were linked to any close other respondents; the results between the 2 survey groups could not be compared as dyads. The study was approved by the Health Research Ethics Board at the University of Manitoba (ethics number: HS24883 [H2021:175]). Per the ethics approval, the need for signed informed consent was waived; a consent disclosure information page proceeded the survey questions for the anonymous surveys.
Materials and procedure
We developed 2 surveys: (1) a 32-item survey for people living with ABI and (2) a 22-item close others survey (supplemental table S1, available online only at http://www.archives-pmr.org/). Survey items were adapted from previous financial-related survey items12,14,15,31,32 and informed by related qualitative studies.7 We developed the surveys with our multidisciplinary research team and piloted the surveys using cognitive interviewing with 2 people living with ABI and 1 caregiver. For survey feasibility and accessibility for our sample populations, per piloting feedback we shortened the length of the survey and have multiple modes for completion for varied needs or preferences (ie, online, mail-in/print, phone).
We mailed survey information, links, a print copy, and an addressed/stamped return envelope through a mailing list (n=175) of a local community brain injury association that provides service and contact throughout our study geopolitical catchment area (ie, province of Manitoba). Further, we shared survey information through this community ABI association email lists and social media. We also attended 2 community online support groups to discuss survey recruitment. Respondents submitted surveys online using a web-platform data capture toola,33; research staff entered mail-in responses received into the online survey option. The survey collection lasted from August to October of 2021 (8 weeks); 4 weeks after the initial recruitment, reminders via social media and email were completed.
Data analysis
No submitted close other survey had missing answers for any items; for living with ABI respondents, 4 items were missing an answer from 1 respondent, and 1 item was missing the answer from 2 respondents. These missing data are reported per item in the results. Each item had answer options “I do not want to answer” or “not applicable.” We descriptively reported any items in which respondents used these response options.
All analyses were conducted using quantitative data-analysis software.b Because of our small sample size, our primary analysis was descriptive analysis (ie, frequency counts or percentage) per question and per each participant group (ie, ABI-survivor vs close other). We completed exploratory nonparametric (nonprobability) inferential statistical analysis, specifically the chi-square test of independence or Fisher exact test, to examine associations between FC and FWB and key variables known to influence FC and FWB (ie, sex, current age, age at injury, and level of education5,6,21,22). To facilitate some analyses and create adequate cell sample sizes for nonparametric inferential analyses, we collapsed some data response options to create binary categories that created large enough cell sizes. Where cell frequencies were less than 5, the Fisher exact test was used to meet required cell size guidance. Provided tables and supplements describe any collapsing of question response options and which statistical test we used per comparison.
Each survey concluded with one open-ended question: Is there anything you think we should know about managing money or finances for someone living with brain injury or stroke? To analyze the narrative (qualitative) data from this question, we used a content analysis approach to create categories supported by the more frequent responses, where new comments did not add more to the category concept or new categories (ie, data saturation34, 35, 36). Content analysis was guided by the framework process.37 One researcher (R.E.) did the initial coding analyses and discussed this coding with 2 other research members familiar with the data (L.E., I.A.). Using multiple perspectives, these 3 researchers reached agreement and categorized the data based on frequency of categories supported by the coded responses.
Results
Demographic characteristics and background information of ABI and close other respondents are described in table 1. Total respondents included 38 respondents who identified as being an ABI survivor and 19 respondents who identified as a close other.
Table 1.
Demographic characteristics of ABI and close other respondents, ABI background and caregiving support
| Demographic Characteristic | ABI (n=38) | Close Other (n=19) |
|---|---|---|
| Age (y) | ||
| 18-25 | 2 (5.3) | – |
| 26-40 | 8 (21.1) | 2 (10.5) |
| 41-55 | 11 (28.9) | 5 (26.3) |
| 56-70 | 11 (28.9) | 9 (47.4) |
| 71 or older | 5 (13.2) | 3 (15.8) |
| I do not want to answer | 1 (2.6) | – |
| Age at first ABI (y) | ||
| Before age 18 | 7 (18.4) | n/a |
| 18-25 | 5 (13.2) | |
| 26-40 | 9 (23.7) | |
| 41-55 | 12 (31.6) | |
| 56-70 | 5 (13.2) | |
| 71 or older | – | |
| Self-reported sex | ||
| Man | 19 (50.0) | 3 (15.8) |
| Woman | 17 (44.7) | 16 (84.2) |
| Nonbinary | 1 (2.6) | – |
| I do not want to answer | 1 (2.6) | – |
| Education | ||
| Less than high school diploma | 6 (15.8) | 2 (10.5) |
| High school diploma or GED | 8 (21.1) | 4 (21.1) |
| College or technical/trade school diploma | 9 (23.7) | 6 (31.6) |
| University undergraduate | 12 (31.6) | 3 (15.8) |
| Masters or Doctorate | 3 (7.9) | 4 (21.1) |
| Years of ABI lived experience* | ||
| Less than 1 | 1 (2.6) | 1 (5.3) |
| 1-5 | 8 (21.1) | 4 (21.1) |
| 6-10 | 9 (23.7) | 4 (21.1) |
| 11 or more | 19 (50.0) | 10 (52.6) |
| I do not know | – | – |
| I do not want to answer | 1 (2.6) | – |
NOTE. Frequencies = counts (%).
Abbreviations: GED, General Educational Development; n/a, not applicable as age at first brain injury was not relevant questions of close other respondents.
Years of lived experience: ABI respondents = years since first brain injury; close other respondents = years providing support to someone living with ABI.
The specific geographic area of residence for most ABI respondents was Winnipeg (n=26; 68.4%), which is the largest/central urban city in Manitoba. This is representative of this province, where approximately 60% of residents lived in this largest/central urban city at the time of this survey. Of the remaining ABI respondents, 5 (13.2%) were from other smaller cities in the province, 4 (10.5%) were from towns, 2 (5.3%) were from rural areas (ie, not a city or town), and 1 (2.6%) chose not to report geographic residence. Respondents had experienced either a TBI (inclusive of postconcussive syndrome/mild TBI and moderate/severe TBI; n=22; 58%), stroke (n=8; 21%), or other ABI mechanisms (n=8; 21%). Except for 1 participant, all ABI respondents had access to a personal or savings account with a bank, credit union, or trust company.
Six of the 19 close others respondents were spouses/partners of someone living with ABI, 6 were parents of someone living with ABI, 6 were other family members of someone living with ABI, and 1 was a paid caregiver/support person of someone living with ABI. Fourteen of the 19 close others had provided care or support for only 1 person who lived with ABI, but 2 close others had provided care for 2 different people who lived with ABI and 3 close others had provided care to 3 or more different people who lived with ABI.
Descriptive item responses to key indicators of FC are presented in figure 1. Responses for key indicators of FWB are presented in table 2. Prioritized key financial learning areas for persons living with ABI from the perspectives of those with ABI and of close others are presented in table 3.
Fig 1.
Frequencies of responses to key indicators of financial capability for ABI and close others: counts.
Table 2.
Frequencies of responses to key indicators of financial well-being for ABI and close others
| ABI (n=38) | Yes or Always/Most of the time* | Sometimes | No or Rarely/ Never† | Do Not Know | Do Not Want to Answer | No. |
|---|---|---|---|---|---|---|
| Currently have enough support or help to complete money or financial tasks | 30 (79.0) | n/a | 8 (21.1) | – | – | 38 |
| Currently have a trusted person in your life with whom you feel safe to talk to about finances | 32 (84.2) | n/a | 6 (15.8) | – | – | 38 |
| Feel that someone has taken advantage of you financially since having ABI/stroke | 11 (29.7) | n/a | 23 (62.2) | 3 (8.1) | – | 37 |
| Told someone other than family, caregivers, or friends that you have ABI/stroke so you could get help or support to complete financial tasks | 16 (42.1) | n/a | 22 (57.9) | – | – | 38 |
| Ever felt unsupported or discriminated against in a financial-related organization or business because you live with ABI/stroke | 9 (23.7) | n/a | 23 (60.5) | 5 (13.2) | – | 38‡ |
| You/your family have difficulty making ends meet at the end of the month | 6 (15.8)* | 11 (30.0) | 18 (47.4)† | n/a | 3 (7.9) | 38 |
| Before the start of the COVID-19 pandemic, ever felt stressed or anxious about money/finances | 7 (18.4)* | 15 (39.5) | 14 (36.8)† | n/a | 2 (5.3) | 38 |
| In the last year, have you ever felt stressed or anxious about money or finances. | 9 (23.7)* | 16 (42.1) | 12 (31.6)† | n/a | 1 (2.6) | 38 |
| Close others (n=19) | ||||||
| Have someone safe to talk to about providing financial-related care or support to someone living with ABI | 13 (68.4) | n/a | – | 2 (10.5) | – | 19§ |
| Stressed or anxious about providing financial-related support or care to someone living with ABI/stroke | 5 (26.3)* | 8 (42.1) | 4 (21.1)† | n/a | – | 19|| |
| Stressed or overwhelmed filling out financial-related forms or applications for persons living with ABI/stroke | 12 (63.2) | n/a | 4 (21.1) | 1 (5.3) | – | 19¶ |
| Feel that someone has ever taken financial advantage of the person living with ABI/stroke that you provide or have provided support | 11 (57.9) | n/a | 7 (36.8) | 1 (5.3) | – | 19 |
NOTE. Frequencies = counts (%). “Last year” = 2020-2021 (survey data collection was from August-October, 2021).
Abbreviation: n/a, not applicable as was not a response option for the item.
Always/most of the time.
Rarely/never.
Item response options included “not applicable” related to persons living with brain injury (n=1; 2.6%).
Item response options included “not applicable” related to the support or care they provided/have provided (n=4; 21.1%).
Item response options included “not applicable” related to the support or care they provided/have provided (n=2; 10.5%).
Item response options included “not applicable” related to the support or care they provided/have provided (n=2; 10.5%).
Table 3.
Areas of financial capability–related knowledge and skills building for people living with ABI
| Survey Items* | ABI† n=38 | ABI Ranking‡ | Close Other* n=19 | Close Other Ranking‡ |
|---|---|---|---|---|
| Accessing money or financial resources | 26 (68.4) | 1 | 13 (68.4) | 1 |
| Where to look for financial advice or help | 18 (47.4) | 2 | 11 (57.9) | 2 |
| Doing financial tasks or activities while living with brain injury symptoms | 17 (44.7) | 3/4 | 10 (52.6) | 5-9 |
| Saving your money | 17 (44.7) | 3/4 | 10 (52.6) | 5-9 |
| Budgeting your money or finances | 16 (42.1) | 5 | 10 (52.6) | 5-9 |
| Managing credit options such as credit cards or loans | 15 (39.5) | 6/7 | 10 (52.6) | 5-9 |
| Staying financially safe or protection from financial fraud or abuse | 15 (39.5) | 6/7 | 15 (79.0) | 3 |
| Keeping track of your money or finances | 14 (36.8) | 8 | 11 (57.9) | 4 |
| Getting debt under control | 13 (34.2) | 9 | 5 (26.3) | 11 |
| Using financial technologies, such as automated teller machines (ATMs), telephone banking, online banking, or mobile banking apps | 11 (29.0) | 10 | 9 (47.4) | 10 |
| Paying for products, services, or bills | 8 (21.1) | 11 | 10 (52.6) | 5-9 |
Survey items. For people living with ABI: Would you like to learn more about or build skills (learn how to do better)? For close others: Do you think that the person/people who live with brain injury or stroke that you provide or have provided support/care would benefit to learn more about or build skills in these areas?
Count (percentage) for response option “Yes” to survey item questions if this was something they wanted to learn more about or build skills (possible response options: Yes, No, I do not know, I do not want to answer).
Ranking = endorsed by number of individuals (ie, Ranking 1 = item that most respondents endorsed as “yes”).
Inferential statistical analyses are presented in supplemental table S2 (available online only at http://www.archives-pmr.org/). From the exploratory inferential analysis, only self-reported sex was statistically significantly associated with feelings of the person living with ABI about their current knowledge and skills for their current financial responsibilities (Fisher exact test, P=.049), with women more likely to report feeling that they had sufficient knowledge and skills.
Using the narrative results, we developed 4 categories to describe the most frequently noted coded and categorized answers about what respondents wanted to express about FC or FWB after ABI. All supporting quotes per category and counts of ABI-survivor vs close other respondents noting information in each category are presented in supplemental table S3 (available online only at http://www.archives-pmr.org/).
FC complexity
Fifteen respondents provided written responses that demonstrated perceived high or challenging FC expectations of persons living with ABI, without a lot of support or consideration for the personal finance and FC complexities that cognitive or functional changes after ABI might impose. As one respondent living with ABI wrote: “This was a huge problem right after my stroke…because I didn't understand…. There should be people to assist and help navigate systems post stroke….there wasn't anyone to help” (ABI-21).
Navigating and accessing financial resources important to FWB
Nine respondents noted challenges after ABI in navigating and accessing financial-related resources to improve FWB. Issues were noted related to knowing what financial resources are available or for which they are eligible, the complex processes to access any resources they might be eligible, or knowing who can help and how to get help. One respondent noted: “It would be helpful to know what resources are available from each level of government and how to access them…Finding these can be difficult” (ABI-9).
Increased financial exploitation vulnerability
Seven respondents noted that living with ABI represented increased perceived incidence or risk of being taken advantage of financially by both those known to them (ie, abuse) or strangers (ie, fraud). This included one respondent who wrote: “This could lead to him being taken advantage of…He was already taken in by a charity” (Close other-13). Both types of respondents noted financial safety concerns and made recommendations for legal systems involvement (eg, in appointing a safe power of attorney) and establishing better processes for reporting and addressing suspected financial fraud or abuse. Some close others noted their role in abuse or fraud protection. As another respondent noted: “Protecting someone with a brain injury when it comes to finances is an important issue that often gets overlooked” (ABI-17).
Employment and income downward shift implications on FWB
Six respondents wrote about the direct economic affect and challenge of ABI on FWB, often experienced as job loss and subsequent downward shift in income after ABI. As one respondent living with ABI noted: “My injury hasn't affected my ability to manage my finances, but it has limited my options for employment…the stress I have is regarding income” (ABI-13).
Discussion
Our study presented data about the FC and FWB experiences for adults living with ABI. Our results highlighted ongoing FC and FWB challenges after ABI. Both people living with ABI and close others in our survey thought ABI influences FC, such as the finance-related choices or decisions, skills, or behaviors of the person living with ABI. Although these are not comparable ABI-survivor and close-other dyads, a greater proportion of close others felt ABI had ever affected the financial decisions or tasks of the person they had provided support (17 of 19 close others) vs ABI survivors themselves feeling ABI had ever affected their financial decisions or tasks (26 of 37 [70.3%]). However, our results also highlight that FWB issues are not only due to FC issues after ABI, but there were also increased rates of our sample of people living with ABI noting socioeconomic contexts that do not support FWB, such as being taken advantage of financially (29.7%), not having enough financial-related support (21.1%), or not having a trusted person to talk to about finances (15.8%).
Although past studies acknowledged financial challenges after ABI,1,3,12,14, 15, 16, 17, 18 our data provide findings about more specific areas of FC and FWB. Finances, as a social determinant of health,11 have been shown to influence many areas of functioning, well-being, recovery, and quality of life after ABI.2,13,27, 28, 29, 30,38 Despite these ongoing identified financial challenges and the implications to the lives of those living with ABI, there remain few evidence-based intervention studies to address the everyday life functioning challenges related to FC after ABI.18,39
We highlight 4 specific findings from our data that we feel are salient to FC and FWB after ABI and novel to highlight in current literature of finances after ABI. First, our results demonstrate the specific FC issues with financial-related technology for people living with ABI.38,40 Financial-related technologies, including online financial management options and automatic teller machines, have changed the way people around the world complete their financial activities and interact with financial-related environments. The rise of telephone and online banking options and access to online financial information (and disinformation) has created opportunities for people living with ABI and other disabilities but also has presented new challenges related to access and inequity.7,41, 42, 43 Our findings provide further evidence of previously noted inequities created by the prevalence of financial-related technologies for people living with disabilities.43,44 Issues with these technologies also may highlight potential vulnerabilities related to security and privacy when people share their confidential information to be able to complete their financial tasks.45 Unfortunately, the digital divide and digital risks may only increase for people living with ABI who experience technology challenges. Yet, participation and performance in using everyday technology is associated with better recovery after ABI.46 Thus, future focus should be on equity-based, safe, and accessible financial-related technologies and how to improve use of financial technologies for people living with ABI.42, 43, 44
Further, of particular concern to FWB was the financial vulnerability of people living with ABI, which can include financial abuse, which is exploitation by people the person knows (eg, family); financial fraud, which is committed by predatory persons previously unknown to the person (eg, strangers); and financial exclusion, which is inadequate or inaccessible relationships with mainstream financial institutions to meet one's financial service needs.47,48 Perceptions of being taken advantage of financially after ABI were reported by 29.7% (ie, 11 of 37) of our respondents who live with ABI, and 11 of 19 close other respondents feeling that the person living with ABI whom they provided support had been taken advantage of financially by another person. However, there is a dearth of literature specific to the areas of financial vulnerability or exploitation after ABI apart from one case-study39 or articles that related to financial abuse and age or comorbid dementia with ABI.47,49 We need to better understand financial exploitation for people living with ABI to create innovative individual and socioeconomic context solutions to decrease financial vulnerability for those living with ABI.
Unsurprisingly, employment and income/financial resources issues after ABI were notable in our findings related to FWB, as has been highlighted in past ABI studies.19,20 However, the salience of income to the discussion of employment is notable. Almost one half (45.8%) of respondents living with ABI reported issues with making ends meet always/most of the time or sometimes, and in our open-ended question narrative data, 5 respondents living with ABI highlighted employment and income changes. However, 4 of these 5 participant responses about employment after ABI were conceptually linked to income and financial burdens of unemployment, and just as many (n=5) of respondents noted issues after ABI in accessing financial resources. Past research has noted increased rates of unemployment, receiving social or income benefits, and low or declining income after ABI, even years after sustaining an ABI and compared with healthy control groups,19,20 which is even more pronounced in people experiencing cognitive impairment after ABI.50 However, our findings build on this knowledge by demonstrating that issues with employment and return to work are not only issues about being able to work or having a job but are also deeply entangled with issues about financial resources and how livable-wage incomes influence FWB. For people living with disabilities, including many living with ABI, low wages for jobs they can get employment, decreased overall hours they are able to work, and potential claw-back of their governmental or insurance benefits if they earn too much monthly income based on benefits income criterion may create situations in which paid employment does not provide a livable income.22,23,51 Yet often, employment-related research of people after ABI does not always disentangle employment outcomes (ie, getting access to a competitive job) to the net economic implications of employment or return to work after ABI. Our results highlight the need for further critical examination of FWB when exploring employment after ABI.
Last, to date no study has examined the FC-related needs of close others who provide support to managing the finances of another adult living with ABI, and our results demonstrate the challenges of close others who support the FC of those living with ABI. Our results highlight providing FC support may be an area of stress or needed support for many involved close others, with 13 of 19 close-other respondents noting providing financial-related support to an ABI survivor was stressful always, most of the time, or sometimes, and 12 of 19 close others reporting filling out financial forms as related to providing someone with ABI financial-related support was stressful always or most of the time. In other diagnostic populations, close others who provide FC support have reported challenges with their own financial knowledge and skills and in addressing the FC skills and knowledge of the person they support,52, 53, 54, 55 and close others’ roles related to finance can increase the complexity and conflict within the caregiving relationship.7,56 Close others’ roles and needs in supporting people living with ABI in financial-related activities should be salient areas for interventions to improve close other and caregivers’ experiences and improving outcomes for people living with ABI and close others.
Limitations and future research
The primary limitations of this study are the sample size and the single geopolitical location, which represents a part of a developed country in the Global North and may limit generalizability. The smaller sample size, although meeting the minimum criteria for any nonparametric analyses completed, decreased the robustness of the inferential statistical analysis, which should be interpreted with caution. Further, these results rely on self-report, and thus, we are not able to confirm specific responses such as medical diagnosis of ABI. For feasibility and survey accessibility, we were limited in the number of items and what we could include. Survey pilots indicated some items for which respondents had challenges responding (eg, TBI severity). Therefore, there are items we did not include, such as information about ABI severity, pre-ABI financial-related information, specific capabilities, current employment and income resources, or specifics of financial exploitation experiences; these areas that should be examined more in-depth in future quantitative and qualitative studies.
Other future research should examine FC and FWB in a larger sample and in different geopolitical contexts. More research, using diverse research methods, is needed into how to address challenges with FC and FWB. This can include accessibility and equity-focused financial technology; the experiences of close others who provide FC support; the relationship of FC and FWB to employment after ABI; addressing financial vulnerability, exclusion, and exploitation after ABI; and how insight or self-awareness after ABI are linked to both FC and FWB after ABI.
Conclusions
Although our sample was small and limited to a specific geopolitical region, our findings support those of others in that they highlight continued FC and FWB challenges, indicating that finances continue to be an unmet need after ABI. This includes an intricate and nuanced relationship between individual knowledge, skills, and applied behavior challenges at the individual level of FC within challenging socioeconomic contexts that also influence FWB after ABI. Therefore, as a salient part of addressing the long-term health, recovery, and well-being of people living with ABI, most likely a comprehensive and multi-faceted approach is needed to address the long-term financial-related issues for people living with ABI and for the people who provide them support.
Suppliers
-
a.
REDCap electronic data capture tools; University of Manitoba
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b.
SAS software version 9.4; SAS Institute Inc
Acknowledgments
We acknowledge the addition to this study from other members of the project advisory group, including the staff and members of the Manitoba Brain Injury Association (MBIA), who provided lived experience perspectives for this project and other researchers involved in the larger MBIA-FEP project. We also thank the staff of MBIA for their support in recruitment advertising and mailing.
Footnotes
Presented to the 2022 Canadian Association of Occupational Therapists conference, May 4-7, 2022, Hybrid, Whistler, Canada; and American Congress of Rehabilitation Medicine Annual Conference, November 8-11, 2022, Chicago, IL.
Supported by in part by the Government of Canada’ Social Development Partnerships Program (Disability component; project number:16684730). The funder did not have influence on the design or analysis of this study. This work is completed and submitted on behalf of the Manitoba Brain Injury Association Financial Empowerment Program (MBIA-FEP) project advisory group. This survey was approved by the University of Manitoba Bannatyne Health Research Ethics Board (HS24883 [H2021:175]).
Disclosures: The authors have no conflicts to report.
Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.arrct.2024.100324.
Appendix. Supplementary materials
References
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