Associations Between Care Environments and Environmental Modifications in the Daily Living Settings of Children with...

Background/Objectives: Children with medical complexity (CMC) living in community settings are increasingly prevalent, and appropriate care environments are essential to support their wellbeing. This study aimed to examine the relationship between care environments and environmental modifications in CMC's daily living, as well as the factors influencing this relationship. Methods: A cross-sectional survey was conducted among families of CMC and professionals (including visiting nurses, consultation support specialists, and other professionals) across Japan. Mann-Whitney U tests were used to examine differences between families and professionals, as well as by the agent of modification. Wilcoxon signed-rank tests were performed to compare environmental scores before and after modifications. Spearman's rank correlation coefficients were used to assess associations between environmental modification scores and post-modification environmental scores. Multiple regression analyses were conducted to identify predictors of post-modification environmental scores, including environmental modification subcategory scores and background characteristics. Results: Valid responses were obtained from 90 families (93.8%) and 221 professionals (76.2%). Significant differences in environmental modification scores were observed between families and professionals. Scores were significantly higher when modifications were conducted jointly by families and professionals and when led by professionals than when implemented solely by families. Pre- and post-modification environmental scores demonstrated significant improvements across all domains-physical, collaborative, service, and community-as well as in total score. Conclusions: Families may underappreciate professional psychological support as part of environmental modifications. Jointly planned, family-centred modifications integrating physical, service, collaborative, and community elements improve care environments and support the wellbeing of CMC and their families.