Environmental Factors Affect Community Participation Among Individuals With MS

Participation in community activities can significantly benefit quality of life among people with multiple sclerosis (MS), but a new report shows how environmental factors can significantly dampen the satisfaction patients derive from such activity.

The study, which was published in PLoS One, is based on both a quantitative assessment of patient data and a set of 4 focus groups that included patients with a range of mobility levels.¹ The study’s goal was to find out how environmental factors (EFs) affect community participation among people with MS (PwMS), how EFs are perceived by people with MS, and how to remedy environmental barriers to community participation.

“Community participation is an important health outcome significantly linked to quality of life among PwMS,” the authors wrote.²

Such research has suggested that individual characteristics of patients, such as sociodemographic factors and functional impairments, play a major role in determining patients’ community participation levels. However, the authors noted that external factors like physical, social, and attitudinal environments also play a role. Specifically, factors like a building’s architectural accessibility, the availability of social opportunities, and the attitudes of the public can play a major role in whether or not patients are willing to participate in community activities.

The investigators observed that current MS interventions tend to focus on patient-level factors, such as managing symptoms and improving physical function.

“Interventions focused on empowering PwMS to navigate environmental barriers and advocating systemic support are limited,” they wrote.

The authors began by using deidentified baseline data from a clinical trial of 505 PwMS between the ages of 45 and 64 years who had acquired physical disability by the age of 40.³ Of those, 122 were invited to participate in a subtrial, in which they were asked to wear a global positioning system (GPS)-based tracker for 7 days to provide data about their community mobility. One hundred of those patients agreed to provide the GPS data.

Following that quantitative phase, the investigators conducted a qualitative phase with 4 focus groups involving 12 PwMS who used mobility aids and another 12 PwMS who did not use mobility aids. The participants were asked about 5 EFs, 5 personal factors (PFs), and 6 community participation outcomes.

The authors found that there was a significant association between PFs and 5 of the 6 community participation outcomes (R² = 13-48%; P < .05). They found that EFs were responsible for an additional 11% variation in satisfaction with community participation and an 11% variation in GPS-based measures of activity, after adjusting for PFs.

When looking at individual EFs, the investigators found that patients who perceived having financial resources were more likely to participate and more likely to be satisfied with their participation in community activities. Patients with social support and safe neighborhoods were more likely to participate in activities, they found.

In the qualitative interview phase, the investigators found that patients who used mobility aids were more likely to report challenges with physical spaces as a barrier to community participation. Those who did not use mobility aids were more likely to raise concerns about the attitudinal environment they might face when participating in community activities.

According to the researchers, the solutions to these barriers are multifaceted.

“Acceptance and adaptation were useful strategies, but participants called for improvements in the built environment, information access, MS specialty care, and public attitudes toward disability,” they wrote.

The investigators concluded further studies should test out potential interventions and policies to see whether they can further empower PwMS to actively participate in their communities.

References

1. Yang B, Molton I, Humbert A, et al. Environmental influences on community participation among people with multiple sclerosis: a mixed methods study. PLoS One. 2026;21(2):e0342678. doi:10.1371/journal.pone.0342678
2. Kwiatkowski A, Marissal JP, Pouyfaucon M, Vermersch P, Hautecoeur P, Dervaux B. Social participation in patients with multiple sclerosis: correlations between disability and economic burden. BMC Neurol. 2014;14:115. doi:10.1186/1471-2377-14-115
3. Molton IR, Singsank K, Rivera N, et al. Can we borrow your intervention? randomized controlled trial of an older adult telehealth wellness promotion program adapted for middle-aged adults with physical disability. Gerontologist. 2025;65(7):gnaf079. doi:10.1093/geront/gnaf079