Abstract
Appropriate wheelchairs are essential for mobility and participation, but their benefits depend on device suitability, user training, maintenance, and accessible environments. This mixed-methods study examined wheelchair provision, functionality, accessibility barriers, and factors associated with reported independent wheelchair use in Albania. Survey data from 807 respondents, including 662 wheelchair users and 145 family proxy respondents, were integrated with five focus group discussions involving 40 wheelchair users. The primary outcome was self- or proxy-reported independent wheelchair use, assessed using a single Yes/No questionnaire item. Among respondents with valid outcome data, 30.9% reported independent wheelchair use. Most wheelchairs were folding models (80.6% of respondents with valid wheelchair-type data). In the complete-case multivariable model (n = 538), wheelchair-use training (OR = 2.14, 95% CI [1.34, 3.42]), wheelchair functionality (OR = 1.41, 95% CI [1.14, 1.76]), ramp access (OR = 3.41, 95% CI [2.10, 5.54]), and male gender (OR = 2.19, 95% CI [1.38, 3.46]) were associated with independent use; maintenance services showed a smaller association (OR = 1.56, 95% CI [1.02, 2.40]). Sensitivity analyses, including multiple imputation and analyses restricted to direct respondents or the two predominant wheelchair types, supported the principal associations. The findings should be interpreted as sample-specific associations rather than causal or population-level estimates and support continued attention to structured wheelchair services, user training, and accessible environments.