より多くを行うことは常に良いことか？多発性硬化症患者の地域参加の主観的側面と客観的側面の関係を調べる混合研究法

Community participation is an important health outcome among people with multiple sclerosis (PwMS) and includes subjective (e.g., satisfaction) and objective aspects (e.g., frequency). Conceptual literature emphasizes the need for measuring both types of aspects to fully understand participation, yet empirical evidence remains limited.

To examine the relationship between subjective and objective aspects of community participation and their associations with person-related and environmental factors.

A mixed methods design was used. Correlation analyses of previously collected self-reported and GPS-based data from 100 PwMS assessed statistical associations between subjective and objective participation. Four focus groups were conducted with 24 PwMS discussing the relationship between participation satisfaction and performance. Qualitative data were analyzed using content analysis.

Moderate to strong correlations (.4-.78, p < 0.001) were found within objective (trip frequency, distance, duration, and activity space) and subjective participation measures (perceived ability and satisfaction). However, associations between subjective and objective aspects were mostly weak (.2-.32, p < 0.05). Person-related and environmental factors showed varying correlations, with generally stronger associations for subjective participation measures (.17 to -.57, p < 0.01) than objective measures (.16-.36, p < 0.05). Aligned with quantitative results, qualitative themes revealed that greater participation quantity may facilitate satisfaction, but frequent and extensive participation is not necessary to reach satisfaction.

This study provides integrated quantitative and qualitative evidence that subjective and objective aspects of participation are related but distinct. Attention must be paid to the divergence between these aspects to address real-world barriers.