Promoting Psychological Health in Women With Spinal Cord Injury: A Randomized Trial

Purpose/Objective: To report on a randomized controlled trial of Zest, a highly innovative psychological health promotion group intervention designed specifically for women with spinal cord injury (SCI), a population at risk for adverse psychological health. Research Method/Design: A national sample of 175 women with SCI were randomized to either the Zest intervention or a control group that received intervention materials at the end of the study. The Zest group participated in a psychological health promotion intervention that met weekly for 10 weeks in the free, online, three-dimensional virtual world of Second Life. The novel use of this technology afforded delivery to participants with SCI without requiring them to leave their homes. Both groups completed online surveys at baseline, at program end, and at 6 months assessing the primary outcomes (depression, self-esteem, and life satisfaction) and the proposed mediators (self-efficacy, connectedness, and perceived stress). Results: Zest was well received by participants. We found significant group differences supporting the efficacy of the intervention on the primary outcomes of depression, self-esteem, and life satisfaction. Analyses also supported self-efficacy and perceived stress as important mediators of the impact of the intervention on the primary outcomes. Conclusion/Implications: Zest, a group program offered on a virtual world platform, offers promise as an intervention for enhancing the psychological health of women with SCI. More attention should be devoted to the psychosocial health needs of people with SCI by developing and implementing affordable, accessible, and widely available programming.