How do environment and place attachment influence social participation among stroke survivors? A mixed-methods study

Social participation refers to individuals' engagement and interaction with others in life situations, despite personal and environmental constraints, and is considered a long-term rehabilitation outcome for stroke survivors. Place attachment describes the emotional bond between individuals and their environment. Numerous studies have examined the influence of physical and social environmental factors on social participation; however, it remains unclear whether the relationships between environmental satisfaction, neighbourhood cohesion, and social participation are mediated by place attachment among stroke survivors. In this mixed-methods study, we hypothesised that place attachment mediates the relationship between environmental satisfaction and social participation, as well as between neighbourhood cohesion and social participation. Quantitative and qualitative data were collected from stroke survivors in two tertiary hospitals in China from March to November 2023. Cross-sectional path analyses revealed that place attachment partly mediated the relationship between environmental satisfaction and social participation, and completely mediated the relationship between neighbourhood cohesion and social participation. Notably, thematic analyses of the qualitative study illustrated that a high-quality supportive environment-characterised by attractiveness, accessibility, sustainability, and adaptability-can strengthen stroke survivors' emotional attachment to their residence and promote social participation. Likewise, strong social bonds with close and reciprocal neighbours, together with responsible community organisations, can foster a sense of belonging and further facilitate participation. The findings support the idea that enhancing residential quality and fostering a sense of neighbourhood closeness, reciprocity, and belonging can strengthen emotional attachment to place, which in turn more effectively promotes social participation among stroke survivors.