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en Mediating Role of Perceived Autonomy between Environmental Accessibility and Activities of Daily Living among Paraplegic Patients 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. Persons with Disabilities,Activities of Daily Living,Paraplegia,Functional Independence, 109 114 http://ijwph.daneshafarand.org/browse.php?a_code=A-10-1-105&slc_lang=en&sid=3 A.A. Kadhim 1003194753284600380456 1003194753284600380456 No Department of Adult Nursing, College of Nursing, University of Thi-Qar, Nasiriyah, Iraq A.A. Abed 1003194753284600380457 1003194753284600380457 Yes Department of Adult Nursing, College of Nursing, University of Thi-Qar, Nasiriyah, Iraq S.A. Laftah 1003194753284600380458 1003194753284600380458 No Department of Community Health Nursing, College of Nursing, University of Thi-Qar, Nasiriyah, Iraq N.N. Abadi 1003194753284600380459 1003194753284600380459 No Department of Community Health Nursing, College of Nursing, Baghdad University, Baghdad, Iraq