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Volume 18, Issue 2 (2026)
3 2026, 18(2): 109-114 |
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Received: 2026/07/1 | Accepted: 2026/06/20 | Published: 2026/06/20
Received: 2026/07/1 | Accepted: 2026/06/20 | Published: 2026/06/20
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Kadhim A, Abed A, Laftah S, Abadi N. Mediating Role of Perceived Autonomy between Environmental Accessibility and Activities of Daily Living among Paraplegic Patients. 3 2026; 18 (2) :109-114
URL: http://ijwph.daneshafarand.org/article-3-85687-en.html
URL: http://ijwph.daneshafarand.org/article-3-85687-en.html
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1- Department of Adult Nursing, College of Nursing, University of Thi-Qar, Nasiriyah, Iraq, Department of Adult Nursing, College of Nursing, University of Thi-Qar, Nasiriyah, Iraq. (alaa-kadhim@utq.edu.iq)
2- Department of Adult Nursing, College of Nursing, University of Thi-Qar, Nasiriyah, Iraq
3- Department of Community Health Nursing, College of Nursing, University of Thi-Qar, Nasiriyah, Iraq
4- Department of Community Health Nursing, College of Nursing, Baghdad University, Baghdad, Iraq
2- Department of Adult Nursing, College of Nursing, University of Thi-Qar, Nasiriyah, Iraq
3- Department of Community Health Nursing, College of Nursing, University of Thi-Qar, Nasiriyah, Iraq
4- Department of Community Health Nursing, College of Nursing, Baghdad University, Baghdad, Iraq
Abstract (143 Views)
Aims: Environmental access is an important determinant of functional independence for individuals with mobility disabilities. Nonetheless, little is known about the role that paraplegic patients’ self-ascribed autonomy plays in this context. This study aimed to test whether perceived autonomy mediates the association between daily living activities and the accessibility of environmental elements in the urban context.
Instrument & Methods: This cross-sectional, descriptive correlational study was conducted on 423 paraplegic individuals in Nasiriyah City, Iraq, from September to October 2025. The Barthel Index was used to measure performance in activities of daily living, the Perceived Autonomy Support Scale for People with Physical Disabilities was used to measure autonomous motivation, and items 11-18 of the Craig Hospital Inventory of Environmental Factors-Short Form were used to assess environmental accessibility. Data were analyzed using SPSS 28 and the PROCESS macro (Model 4) for mediation analysis, as well as Pearson’s correlation.
Findings: The association of perceived autonomy with activities of daily living (r=0.623; p<0.001) was positive, while environmental accessibility showed negative correlations with both activities of daily living and perceived autonomy (r=-0.512 and r=-0.474, respectively; p<0.001). Mediation analysis confirmed a significant indirect effect of environmental accessibility on activities of daily living through perceived autonomy (B=-0.224; 95%CI: -0.296, -0.159). The combined model explained 45.1% of the variability in activities of daily living performance.
Conclusion: Perceived autonomy mediates the relationship between environmental accessibility and functional independence.
Instrument & Methods: This cross-sectional, descriptive correlational study was conducted on 423 paraplegic individuals in Nasiriyah City, Iraq, from September to October 2025. The Barthel Index was used to measure performance in activities of daily living, the Perceived Autonomy Support Scale for People with Physical Disabilities was used to measure autonomous motivation, and items 11-18 of the Craig Hospital Inventory of Environmental Factors-Short Form were used to assess environmental accessibility. Data were analyzed using SPSS 28 and the PROCESS macro (Model 4) for mediation analysis, as well as Pearson’s correlation.
Findings: The association of perceived autonomy with activities of daily living (r=0.623; p<0.001) was positive, while environmental accessibility showed negative correlations with both activities of daily living and perceived autonomy (r=-0.512 and r=-0.474, respectively; p<0.001). Mediation analysis confirmed a significant indirect effect of environmental accessibility on activities of daily living through perceived autonomy (B=-0.224; 95%CI: -0.296, -0.159). The combined model explained 45.1% of the variability in activities of daily living performance.
Conclusion: Perceived autonomy mediates the relationship between environmental accessibility and functional independence.
Keywords:
References
1. Widagdo MM, Robot MM, Pinzon RT. Independence in activities of daily living and quality of life of community-dwelling persons with paraplegia in Indonesia. Int J Disabil Hum Dev. 2021;20(3). [Link]
2. Rantanen T. Functional capacity, activities, and participation. In: Advancing research on active aging and participation: A public health approach. Cham: Springer; 2025. p. 51-72. [Link] [DOI:10.1007/978-3-031-94702-5_6]
3. Abed Laftah S, Kadhim Abdul-Hameed A, Zair Balat K, Malih Radhi M. Barriers and facilitators in rehabilitative nursing care for disabilities and mediating roles of nurse-related factors. Iran Rehabil J. 2025;23(2):165-74. [Link] [DOI:10.32598/irj.23.2.1989.4]
4. Al-Eqabi QA, Niazy SM, Radhi MM. Amputation-related factors influencing activities of daily living among amputees. Iran J War Public Health. 2024;16(2):123-9. [Link]
5. Da Silva MB, Moschen SD, Cecatto B, Larentis F. Perceived attributes and dimensions of accessibility in adapted bathrooms. Build Res Inf. 2022;50(1-2):60-73. [Link] [DOI:10.1080/09613218.2021.1943643]
6. Botticello AL, Tulsky D, Heinemann A, Charlifue S, Kalpakjian C, Slavin M, et al. Contextualizing disability: A cross-sectional analysis of the association between the built environment and functioning among people living with spinal cord injury in the United States. Spinal Cord. 2019;57(2):100-9. [Link] [DOI:10.1038/s41393-018-0186-8]
7. Gurung S, Jenkins HT, Chaudhury H, Ben Mortenson W. Modifiable sociostructural and environmental factors that impact the health and quality of life of people with spinal cord injury: A scoping review. Top Spinal Cord Inj Rehabil. 2023;29(1):42-53. [Link] [DOI:10.46292/sci21-00056]
8. Márquez L, Poveda JC, Vega LA. Factors affecting personal autonomy and perceived accessibility of people with mobility impairments in an urban transportation choice context. J Transp Health. 2019;14:100583. [Link] [DOI:10.1016/j.jth.2019.100583]
9. Radhi MM, Al-Eqabi QA, Hindi NK. Rehabilitation problems of people with motor disabilities at Babylon center for rehabilitation of the disabled. Med J Babylon. 2023;20(4):838-43. [Link] [DOI:10.4103/MJBL.MJBL_674_23]
10. Lili L, Sunnerhagen KS, Rekand T, Alt Murphy M. Participation and autonomy, independence in activities of daily living and upper extremity functioning in individuals with spinal cord injury. Sci Rep. 2024;14(1):9120. [Link] [DOI:10.1038/s41598-024-59862-2]
11. Juma Elywy G, Radhi MM, Khyoosh Al-Eqabi QA. Social support and its association with the quality of life (QoL) of amputees. Iran Rehabil J. 2022;20(2):253-60. [Link] [DOI:10.32598/irj.20.2.1784.1]
12. Friman M, Olsson LE. Are we leaving some people behind? Travel autonomy, perceived accessibility, and well-being among people experiencing mental and physical difficulties. Transp Res Part F Traffic Psychol Behav. 2023;98:243-53. [Link] [DOI:10.1016/j.trf.2023.08.009]
13. Malih Radhi M, Juma Elywy G, Abbas Khyoosh Al-Eqabi Q. Burdens among wives of disabled people in the light of some social variables. Iran Rehabil J. 2023;21(3):473-84. [Link] [DOI:10.32598/irj.21.3.1765.3]
14. Niazy SM, Abadi NN, Radhi MM, Al-Eqabi QA, AL-Thabhawee GD. Impact of digital health literacy on quality of life among people with physical disabilities. Iran J War Public Health. 2025;17(2):197-203. [Link] [DOI:10.58209/ijwph.17.1.83]
15. Blank R, Barnett AL, Cairney J, Green D, Kirby A, Polatajko H, et al. International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder. Dev Med Child Neurol. 2019;61(3):242-85. [Link] [DOI:10.1111/dmcn.14132]
16. Philp KD, Babb KE. Understanding motivations for gang joining using self-determination theory: Implications for youth mentoring programs. Vict Offenders. 2025;1:1-31. [Link] [DOI:10.1080/15564886.2025.2509313]
17. Whiteneck GG, Harrison-Felix CL, Mellick DC, Brooks CA, Charlifue SB, Gerhart KA. Quantifying environmental factors: A measure of physical, attitudinal, service, productivity, and policy barriers. Arch Phys Med Rehabil. 2004;85(8):1324-35. [Link] [DOI:10.1016/j.apmr.2003.09.027]
18. Simon MA. The graduate thesis of Cherlou U. Valencia is approved [dissertation]. Madurai: American College; 2007. [Link]
19. Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: A reliability study. Int Disabil Stud. 1988;10(2):61-3. [Link] [DOI:10.3109/09638288809164103]
20. Balat KZ, Laftah SA, Radhi M. The relationship between psychological distress and quality of life among women undergoing mastectomy in Iraq: A descriptive correlational study. Natl J Community Med. 2025;16(1):20-7. [Link] [DOI:10.55489/njcm.160120254716]
21. Yaqoub RH, Abdulwahid HS. Self-body image and its association to quality of life among women undergoing to mastectomy. Oncol Radiother. 2023;17(7):213-6. [Link]
22. Van Loon J, Luijkx K, Janssen M, De Rooij I, Janssen B. Facilitators and barriers to autonomy: A systematic literature review for older adults with physical impairments, living in residential care facilities. Ageing Soc. 2021;41(5):1021-50. [Link] [DOI:10.1017/S0144686X19001557]
23. Malih Radhi M, Zair Balat K. Health literacy and its association with medication adherence in patients with hypertension: A mediating role of social support. Iran Rehabil J. 2024;22(1):117-28. [Link] [DOI:10.32598/irj.22.1.1989.1]
24. Saketkoo LA, Escorpizo R, Varga J, Keen KJ, Fligelstone K, Birring SS, et al. World Health Organization (WHO) international classification of functioning, disability and health (ICF) core set development for interstitial lung disease. Front Pharmacol. 2022;13:979788. [Link] [DOI:10.3389/fphar.2022.979788]
25. Guay F. Applying self-determination theory to education: Regulations types, psychological needs, and autonomy supporting behaviors. Can J Sch Psychol. 2022;37(1):75-92. [Link] [DOI:10.1177/08295735211055355]
26. Cole S, Deci EL, Zhao H, Wang W. How environmental and psychological factors interact with travel participation after spinal cord injury. Rehabil Psychol. 2022;67(2):152-61. [Link] [DOI:10.1037/rep0000439]
27. Yasir AA, Qassim WJ, Radhi MM. Assessment the feeling of psychological loneliness among wives of martyrs in the light of some social variables in Babylon Governorate/Iraq. J Pharm Sci Res. 2018;10(1):40-4. [Link]
28. Zhang D, Bobis J, Wu X, Cui Y. The effects of an autonomy-supportive teaching intervention on Chinese physics students and their teacher. Res Sci Educ. 2020;50(2):645-71. [Link] [DOI:10.1007/s11165-018-9706-y]