Qom University of Medical Sciences Journal

Introduction
The goal of rehabilitation for people with spinal cord injury is to return to society and improve their quality of life so that returning to work has been proposed as an indicator of successful rehabilitation. Social integration of people with spinal cord injury is a key goal of rehabilitation. Considering the importance of self-efficacy as one of the individual factors affecting social integration, this study aimed to investigate the status of self-efficacy and social integration in people with spinal cord injury in Saqez City in 2022.
Methods
This cross-sectional descriptive study was conducted in Saqez City, Kurdistan Province, Iran, in 2022. The community integration questionnaire (CIQ) and general self-efficacy questionnaire were used to collect data. The information was collected with the cooperation of the rehabilitation unit of the welfare department, the relief committee, the Martyr Foundation of Saqqez City, and the social worker for people with spinal cord injuries. Among them, only a few people were unable to be interviewed in person; thus, the questionnaire was completed with the assistance of a social worker and over the phone. At least one year had passed since the spinal cord injury, and being over 18 years of age was the inclusion criterion, while incomplete completion of the questionnaires was considered an exclusion criterion. Descriptive information on spinal cord injury patients was analyzed using Mean±SD, and normality of variables was assessed using the Kolmogorov-Smirnov test. Spearman’s correlation coefficient was used to check the correlation between social integration and self-efficacy scores. Data were analyzed using SPSS software, version 16. 
Results
99 people participated in this study, of whom 72 cases (72.73%) were men. The mean age was 44.67±13.91 years. Most participants 33(33.33%) had primary education. The mean total self-efficacy score, the initiation subscale score, the homework completion subscale score, and the resistance in facing the obstacles subscale score for the investigated spinal cord injury subjects were 57.17±7.17 (above average), 13.01±2.68 (above average), 19.44±3.46 (above average) and 22.23±3.75 (lower than average), respectively. More than half of the participants had self-efficacy scores above average, and none had low self-efficacy scores; however, only the subscale score for resistance in facing obstacles was below average. Age had a significant negative correlation with the integration score (r=–0.375; P=0.001). In this study, the mean total integration score, home integration subscale score, community integration score, and productivity integration score were 12.95±6.61 (lower than average), 3.57±3.27, 7.00±2.82, and 2.38±1.48, respectively. The mean total integration score was lower than average, with the integration score in the sub-scale of integration in society being average, while the sub-scales of integration at home and integration in productivity were much lower than average. As the self-efficacy score and its subscales increase, the values of integration scores at home, integration in society, integration in productivity, and the total integration score also increase significantly. In the present study, as well as in most of the studies reviewed, men accounted for a higher percentage of spinal cord injury cases. The mean scores for the integration dimensions, except for integration at home, were higher in men than in women. There was no significant relationship between the subscale scores and the total self-efficacy score with gender. In other words, being male or female had no significant effect on the self-efficacy score.
Conclusion
According to the self-efficacy scores (slightly higher than average) and social integration scores (lower than average) of people with spinal cord injuries in Saqqez, it seems that to improve the social integration of these individuals, it is advisable to take steps to enhance their self-efficacy within the framework of rehabilitation programs. In rehabilitation programs, it is essential to establish active counseling centers to foster self-awareness and internal motivation in these people. Additionally, enhancing self-efficacy through measures such as strengthening resilience, expanding social networks, providing social support, and increasing participation in exercise and physical activity can benefit people with spinal cord injuries. These efforts can increase the social integration of people with spinal cord injury. The limited sample size of 99 people in Saqqez City may limit the results of the study to this particular region and reduce the ability to generalize findings to other regions of the country.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran (Code: IR.USWR.REC.1401.188). Before completing the questionnaire, participants were assured that their personal information would be kept confidential and informed consent was obtained from them before participation. They were also assured that participating in the research would not result in any losses for them. Individuals who did not wish to continue their cooperation were free to withdraw from the research at any time. 
Funding
This study was extracted from the master’s thesis of Delnia Nikuee, approved by the Department of Rehabilitation Management, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. 
Authors contributions
All authors contributed equally to the conception and design of the study, data collection and analysis, interception of the results and drafting of the manuscript. Each author approved the final version of the manuscript  for submission.
Conflicts of interest
The authors declared no conflict of interest.