Environmental influences on anxiety, perceived stress and walking levels in people with epilepsy: A qualitative study...

Only 35% of people with epilepsy (PWE) meet the physical activity (PA) guidelines, despite PA having stress-, anxiety-reducing and antiepileptic effects. Stress and anxiety are common seizure triggers and important barriers to PA. Walking is an accessible and feasible form of PA that should be encouraged in PWE. Although social and physical characteristics of neighborhood environments influence walking in the general population, evidence in PWE is lacking. This study explored how social and physical environmental factors influence walking among adults with drug-resistant epilepsy (DRE), both directly and indirectly through their impact on seizure-related anxiety and perceived stress.

Twenty adults with DRE participated in qualitative walk-along interviews within their neighborhoods. Interviews were analyzed through combined inductive and deductive content analysis in MAXQDA Analytics Pro.

Social support, companionship, and familiarity with residents reduced seizure-related anxiety and increased walking confidence. Natural elements, familiar routes, perceived safety, and low-traffic surroundings lowered stress and supported walking. Neighborhood services improved convenience and invitingness of walking. Stressors such as noise, crowds, and unfamiliar environments increased anxiety and discouraged walking, whereas the use of coping strategies (e.g., headphones or choosing familiar routes) helped manage anxiety during walks.

Promoting walking in PWE requires a multilevel approach. Interventions should focus on strengthening coping strategies, enhancing social support, and integrating environmental adaptations to create safe walking opportunities. This study is the first to prospectively explore how environmental factors influence stress, anxiety, and walking in PWE through walk-along interviews, a feasible method yielding unique, context-specific insights.