Exploring participation after traumatic brain injury: a qualitative meta-synthesis guided by the social ecological model

PURPOSE: Research on participation after traumatic brain injury (TBI) has focused predominantly on frequency-based, individual-level outcomes, overlooking how systemic and interpersonal contexts shape participation. While qualitative research has explored these influences, the literature remains fragmented. The purpose of this study was to synthesize qualitative literature on participation experiences of individuals with TBI, focusing on systemic, interpersonal, and individual influences. MATERIALS AND METHODS: We conducted a meta-synthesis following ENTREQ guidelines, searching five databases from inception to July 2026. We included qualitative studies examining participation among adults with TBI. We synthesized results using Thomas and Harden's thematic synthesis, guided by the social ecological model. RESULTS: Of 3140 studies, 28 met inclusion criteria. Three themes emerged: (1) environmental challenges and adaptation described how systemic barriers placed adaptive burden on individuals, mediated by interpersonal support; (2) stigma and support in social participation examined how societal stigma shaped relationships, exacerbating symptoms and withdrawal; and (3) cultural narratives and identity highlighted how dominant narratives influence self-perception and participation satisfaction. CONCLUSIONS: Participation after TBI is shaped by the interplay of systemic, interpersonal, and individual factors. Future research should address systemic and interpersonal influences, fostering environments, relationships, and narratives that promote meaningful participation and inform multi-level interventions.