How Community Nurses Modify Relational, Social, and Institutional Environments to Enable Participation in a Rural Japanese Village: A Secondary Qualitative Analysis

Background/Objectives: Participation is a central outcome of rehabilitation and is influenced by environmental factors, as described in the International Classification of Functioning, Disability and Health (ICF). However, environmental factors are often conceptualized as static conditions, and the mechanisms through which healthcare professionals actively modify environments to enable participation remain insufficiently understood. This study aimed to examine how community nurses modify environmental factors to enable participation in community settings. Methods: This qualitative study conducted a secondary analysis of 10 available monthly Community Nurse activity logs and reflective practice records from January, February, April, and June to December 2025 in a rural community. Thematic analysis was performed to identify patterns in how community nurses modified environmental contexts to enable participation. Analysis was informed by the environmental factors component of the ICF framework. Results: Four interrelated environmental modification processes were identified: creating participation-enabling social environments; strengthening relational environments through trust and validation; restructuring social roles and participation expectations; and bridging digital, structural, and institutional barriers to participation. Community nurses facilitated recreational and social activities, invited residents who were not yet participating in ongoing activities, coordinated with local organizations, and supported reciprocal resource sharing. These actions reconstructed participation environments, enabling residents to engage in meaningful social interaction, assume active roles, and sustain community engagement. Conclusions: Community nurses enabled participation by actively modifying environmental factors across physical, relational, and institutional domains. Environmental modification functioned as a key mechanism enabling participation in community-based rehabilitation. These findings operationalize the environmental factors component of the ICF framework and highlight the importance of environmental facilitation in participation-oriented rehabilitation.