Structure and Conceptualization of Acceptance: A Split-sample Exploratory and Confirmatory Factor Analysis Approach to Investigate the Multidimensionality of Acceptance of Spinal Cord Injury

OBJECTIVE: To determine the multidimensionality of acceptance of spinal cord injury (SCI).

PARTICIPANTS: Adults with SCI who were admitted to an SCI centre between 1991 and 2020.

METHODS: All eligible participants (n=686) were invit-ed to complete a survey via REDCap. A 4-dimensional model was hypothesized, which included "Accepting Reality", "Value Change", "Letting Go of Control" and "Behavioural Engagement". Items from 3 accept-ance scales were selected to collectively reflect these 4 dimensions: (i) Spinal Cord Lesion-related Coping Strategies Questionnaire, (ii) Coping Orientations to Problems Experienced, and (iii) a modified Acceptance and Action Questionnaire. A split-sample principal component analysis (PCA) and confirmatory factor analysis (CFA) approach was used.

RESULTS: Complete data were provided by 431 participants (62.8%). A PCA on sub-sample one suggest-ed a 4-factor model based on eigenvalues ≥ 1, corresponding to the hypothesized model of acceptance. A CFA on sub-sample 2 showed good model fit, adding further support to the model.

CONCLUSION: These findings suggest that acceptance is a multidimensional construct with 4 facets that represent distinct, but interconnected, psychological processes. This model of acceptance can be used as a framework for future research and clinical practice to deepen our understanding of acceptance processes following severe injuries, such as SCI.