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Volume 18, Issue 2 (2026)
Iran J War Public Health 2026, 18(2): 109-114 |
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Received: 2026/01/11 | Accepted: 2026/02/27 | Published: 2026/03/19
Received: 2026/01/11 | Accepted: 2026/02/27 | Published: 2026/03/19
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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. Iran J War Public Health 2026; 18 (2) :109-114
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URL: http://ijwph.ir/article-1-1737-en.html
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1- Department of Adult Nursing, College of Nursing, University of Thi-Qar, Nasiriyah, Iraq
2- Department of Community Health Nursing, College of Nursing, University of Thi-Qar, Nasiriyah, Iraq
3- Department of Community Health Nursing, College of Nursing, Baghdad University, Baghdad, Iraq
2- Department of Community Health Nursing, College of Nursing, University of Thi-Qar, Nasiriyah, Iraq
3- Department of Community Health Nursing, College of Nursing, Baghdad University, Baghdad, Iraq
Abstract (292 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.