Reliability and validity of the Chinese version of a short form of the family health scale

The associations of anxiety, self-efficacy, and family health with obesity-related eating behavior among Chinese adults

BACKGROUND/OBJECTIVE

Relationships among anxiety, self-efficacy, family health, and obesity-related eating behavior (OREB) have not been comprehensively investigated as a holistic system. This study aimed to explore the profiles of anxiety, self-efficacy, and family health in the adult population, and to test their differences in OREB. Furthermore, this study simultaneously examined the moderating effects of self-efficacy and family health on association between anxiety and OREB.

METHOD

This study analyzed a nationally representative dataset from the Psychology and Behavior Investigation of Chinese Residents (PBICR) with a sample of 9091 Chinese adults. All participants completed validated questionnaires for study variables. Latent profile analysis (LPA) was used to identify profiles of anxiety, self-efficacy, and family health. ANOVA was performed to examine the differences in OREB among various profiles. Moderation analysis was conducted to test the moderation effects of self-efficacy and family health.

RESULTS

Three profiles of anxiety, self-efficacy, and family health were identified, with 25.31 % of participants being classified into the "High anxiety with low levels of self-efficacy and family health" group, which showed the highest level of OREB among the three profiles. Self-efficacy (B = 0.04, 95 % CI = [0.026, 0.062]) and family health (B = 0.06, 95 % CI = [0.040, 0.086]) showed significant moderation effects, with higher self-efficacy and higher family health strengthening the relationship between anxiety and OREB.

CONCLUSIONS

Individuals with anxiety are at an elevated risk of developing unhealthy eating behaviors. Additional attention should still be paid to those with high levels of self-efficacy and family health.

Structure of family health and its association with obesity-related eating behavior and depressive symptoms: Insights from network analysis

The health of families is inextricably linked to the health of individuals and communities, providing the foundation for their development. Family health is a multifaceted concept and has been suggested to impact individuals' obesity-related eating behavior and the alleviation of depressive symptoms. However, existing studies have not comprehensively examined the structure of family health and its' potential associations with obesity-related eating behavior and depressive symptoms. The present study employed network analysis to ascertain the most pivotal characteristics within the interdisciplinary and holistic concept of family health. In addition, this study investigated the moderating effect of family health on the association between obesity-related eating behavior and depressive symptoms, and identified the characteristics of family health that were the most strongly linked to the association. A total of 9091 adults participated in this nationally representative study between 10 July and September 15, 2021. The participants completed self-report assessments of family health, obesity-related eating behavior, and depressive symptoms. The results of network analysis indicated that helping each other in seeking health care services when needed (such as making physician's appointments) had the highest node expected influence (1.154) within the network. The results of moderation analysis showed that family health significantly buffered the association between obesity-related eating behavior and depressive symptoms (B = -0.06, 95 % CI = -0.077, -0.042). Further investigation demonstrated that not trusting doctors and other health professionals in the family presented the strongest negative correlation (-0.125) with obesity-related eating behavior, and not having adequate housing in the family showed the strongest negative correlation (-0.069) with depressive symptoms. These findings provide further insight into the critical aspects of family health and its significant correlations with obesity-related eating behavior and depressive symptoms.

Understanding Chinese adults' attitudes toward nurse prescribing: A national cross-sectional study

BACKGROUND

Limited studies have investigated the attitudes of Chinese adults toward the role of nurse prescribing, particularly based on population-based cross-sectional research.

OBJECTIVE

To investigate the associations of socio-demographic and health-related factors with the acceptance of the role of nurse prescribing.

DESIGN

A cross-sectional study.

SETTING

In China.

PARTICIPANTS

A total of 30,054 participants were included in this study.

METHODS

We employed univariate generalized linear model and multivariable generalized linear model analyses to explore the factors that were associated with the acceptance of the role of nurse prescribing.

RESULTS

Individuals of older age (β: 0.08, 95 % CI: 0.05-0.10) and residing in the Western region of China (β: 1.99, 95 % CI: 1.29-2.70), with average monthly household income per capita in the range of 3001-6000 (β: 2.58, 95 % CI: 1.84-3.32) and ≥ 6001 (β: 3.90, 95 % CI: 3.01-4.80), as well as those reporting higher levels of perceived social support (β: 0.46, 95 % CI: 0.35-0.56), better self-rated health status (β: 0.15, 95 % CI: 0.14-0.17), and increased eHealth literacy (β: 0.61, 95 % CI: 0.53-0.68), tend to demonstrate an inclination toward accepting nurse prescribing.

CONCLUSIONS

These findings provide valuable insights for healthcare policymakers and practitioners aiming to promote the integration of nurse prescribing into the Chinese healthcare system. Our results emphasize the need for targeted interventions to address barriers to acceptance and enhance the accessibility and utilization of nurse-prescribing services among diverse demographic characteristics.

Acceptance of advance care planning among older adults in Mainland China: a national cross-sectional study

BACKGROUND

Acceptance of advance care planning (ACP) among older adults is important for the promotion of ACP. It is of great importance to explore the acceptance of ACP and associated influencing factors among older adults in China based on the health ecology model (HEM).

METHODS

Based on a national cross-sectional study in 2022, 4,180 older adults were included. Stepwise linear regression was used to analyze factors associated with acceptance of ACP using SPSS 26.0, based on the HEM. Acceptance scores were calculated based on a self-assessment visual analog scale (range, 0 ~ 100, with higher scores indicating higher acceptance of ACP).

RESULTS

50.05% (2,092) of 4,180 participants were female. The median acceptance of ACP score was 64, and the range was (49, 81). In addition, the study found higher well-being index (β = 0.086; 95% CI, 0.199 to 0.535; P < 0.001) and health literacy (β = 0.054; 95% CI, 0.07 to 0.423; P = 0.006) scores, broader media use behaviors (β = 0.064; 95% CI, 0.127 to 0.419; P < 0.001), and a higher per capita monthly household income (β = 0.086; 95% CI, 1.827 to 3.825; P < 0.001) were associated with a higher acceptance of ACP, while participants with higher depression scores (β = -0.06; 95% CI, -0.435 to -0.129; P < 0.001), larger social network (β = -0.054; 95% CI, -3.289 to -0.937; P < 0.001), and health insurance (β = -0.04; 95% CI, -7.294 to -1.027; P = 0.008) demonstrated a lower acceptance of ACP.

CONCLUSIONS

For the first time, this study revealed basic personal information, economic status, media use, social networks, health knowledge, and mental health as the main factors associated with acceptance of ACP among older adults in mainland China. These findings were of great significant for enhancing healthcare quality and the overall quality of life for older adults in China.

Physical, Mental, and Health Empowerment Disparities Across Chronic Obstructive Pulmonary Disease, Asthma, and Combined Groups and the Moderating Role of eHealth Literacy: Cross-Sectional Study

BACKGROUND

Nonpharmacological management plays a key role in enhancing the quality of life for individuals with chronic obstructive pulmonary disease (COPD), asthma, or both. However, disparities in their physical, mental, and health empowerment outcomes have not been fully explored, particularly in relation to the moderating effect of eHealth literacy.

OBJECTIVE

This study aims to assess these disparities and examine how eHealth literacy moderates them to guide the development of tailored nonpharmacological strategies.

METHODS

We analyzed data from 2 waves of the nationally representative "Psychology and Behavior Investigation of Chinese Residents" surveys to identify participants who self-reported asthma, COPD, or both. We assessed 5 physical outcomes (quality of life, physical activity, sleep quality, appetite, nicotine dependence), 4 mental outcomes (anxiety, depression, perceived stress, resilience), and 3 health empowerment measures (social support, self-efficacy, eHealth literacy). Multiple regression with Holm-Bonferroni corrections revealed health disparities and the moderation effect of eHealth literacy.

RESULTS

This unfunded study enrolled 1044 participants between June 2022 and August 2023, with data analysis completed within 7 months following data collection. The sample included 254 (24.3%) participants with asthma, 696 (66.7%) participants with COPD, and 95 (9.1%) participants with both conditions. The mean age of the participants was 48.61 (SD 19.70) years, and 536 (51.3%) participants were male. Linear regression showed that individuals with both COPD and asthma had lower health-related quality of life and higher anxiety and depression compared with those with either condition alone (b ranges from -0.15 to 3.35). This group also showed higher nicotine dependence than asthma-only (b=0.88) and lower resilience than COPD-only groups (b=-0.76) (all adjusted P<.05). eHealth literacy significantly moderated the effect of the disease group on all outcomes except physical activity (all adjusted P for interaction <.05). Nine disease pairs showed disparities in both eHealth literacy groups, 4 only in high literacy, and 8 only in low literacy (all P<.05).

CONCLUSIONS

Individuals with both COPD and asthma had poorer quality of life, greater anxiety and depression, higher nicotine dependence, and lower resilience, underscoring the need for integrated psychosocial and behavioral interventions. Although higher eHealth literacy was associated with improved quality of life, sleep quality, and resilience, it also widened disparities in anxiety and depression. Therefore, while enhancing eHealth literacy may help reduce overall health inequities among patients with chronic respiratory diseases, its potential adverse effects on mental well-being warrant careful attention. Moreover, lower eHealth literacy was linked to more pronounced disparities, indicating that outreach efforts and digital resources should be specifically designed to reach and empower vulnerable populations. Overall, our findings advocate for condition-specific, eHealth-enhanced care pathways that not only foster digital literacy but also integrate comprehensive mental health services, thereby mitigating health disparities among individuals with chronic respiratory diseases.

Prevalence and associated factors influencing the use of antibiotics for self-medication among Chinese residents: a cross-sectional study in 2021

BACKGROUND

Self-medication with antibiotics (SMA) is increasingly occurring worldwide, yet it is a process that can lead to inappropriate use of antibiotics, with potentially multiple adverse consequences such as an increased risk of antibiotic resistance.

OBJECTIVE

The objective of this study is to assess the prevalence of self-medication with antibiotics among the Chinese population and investigate the factors associated with this behavior.

METHODS

A multi-stage sampling method was employed to carry out a national cross-sectional questionnaire survey among Chinese individuals aged 18 years and above from July 10, 2021, to September 15, 2021. Following the statistical analysis of the collected data, binary logistic regression was applied to identify the factors associated with respondents' self-medication with antibiotics. Model robustness testing was also performed using best subset regression.

RESULTS

From a total of 11,031 questionnaires, 9,344 qualified samples were selected. The prevalence of self-medication with antibiotics among Chinese residents was found to be 34.63% (3,237/9,344). The most important factor considered in SMA was the advice of medical professionals, accounting for 89.00%, including recommendations from doctors (2,524/3,237, 77.97%) and pharmacists (1,905/3,237, 58.85%). The results of the binary stepwise logistic regression analysis showed that female, people older than 36 years, with higher education, had consumed alcohol in the past month, with mild depression, having residential or employee health insurance as the primary form of health coverage, having commercial insurance, having better family health status, and perceiving higher levels of social support were more likely to practice SMA (P < 0.05). Conversely, individuals diagnosed with major depressive disorder were found to be less likely to engage in self-medication with antibiotics (P < 0.05). The best subset regression method and stepwise regression method gave the same results.

CONCLUSION

The SMA issue of Chinese residents is still relatively serious. Residents' SMA was associated with their demographic and sociological characteristics, depression, family health, and perceived level of social support. The primary consideration for resident SMA is the advice of medical staff. The problem of SMA in China should be improved through antibiotic management, education on antibiotic knowledge, and medical staff's correct guidance.

The Relationship Between Personality and Self-Management Behavior in Chinese Young and Middle-Aged People with Chronic Illness: The Chain Mediating Role of Family Health and Health Literacy

Purpose

Although the factors influencing chronic disease self-management have been extensively investigated, the ways in which personality traits, family health, and health literacy influence self-management require further exploration. This study aimed to explore the relationships and pathways among personality traits, family health, health literacy, and chronic disease self-management, with the goal of providing insights for chronic disease management.

Patients and Methods

This study was based on a national cross-sectional survey conducted in 2021, which included 1063 young and middle-aged individuals (aged 19-59) with chronic diseases. Structural equation modeling was used to analyze the path relationships between personality traits, family health, health literacy, and chronic disease self-management levels.

Results

Agreeableness directly and negatively predicted self-management outcomes (estimate: -0.557, 95% CI: -0.964 to -0.149). When examining health as the mediating variable between personality traits and self-management, it was observed that although different personality traits exert either positive or negative influences on family health, family health invariably had negative impact on self-management to varying extents (βextraversion: -0.111, P<0.01; βagreeableness: -0.083, P<0.05; βconscientiousness: -0.113, P<0.01; βneuroticism: -0.111, P<0.01; βopenness: -0.107, P<0.01). However, when considering the chain mediation effect, family health could positively influence health literacy, which subsequently had a beneficial impact on self-management. Additionally, health literacy served as an independent mediator in the relationship between extraversion and openness and self-management, with indirect effects of 0.163 and 0.274, respectively.

Conclusion

Different personality traits exerted varying effects on self-management, which could be either direct or indirect, through the mediating roles of family health and health literacy. Family health seemed to be a double-edged sword for self-management. Future chronic disease self-management should consider the importance of family health, health literacy, and the complex pathways through which personality traits influence management behaviors, to maximize self-management outcomes.

Willingness to bear the first child among the Chinese childless population: a national survey study

BACKGROUND

Having a first child is a contributing factor to having a second or third child; however, current research focuses on second and third children, and the present study aims to investigate the intention to have a first child and its main influencing factors among the childless population aged 15-49 in China, as well as analysing the influencing factors by age group.

METHOD

As part of the 'Survey on the Psychology and Behaviour of Chinese Residents', this survey was conducted on 6941 residents aged 15-49 in 32 provinces across China. The survey was conducted from 20 June to 31 August 2022.

RESULT

Out of 6941 respondents, the mean score of willingness to have a first child (score range: 0-100) was 42.51. 17.33% of the respondents had no willingness to have a child (0), while 9.54% had a high willingness to have a child (100). Intention to have a first child seems to peak in the age group 30-34 years (p < 0.0001). Being male (p < 0.000, OR = 0.178), having siblings (p1 < 0.035, OR1 = 1.324; p2 < 0.000, OR2 = 1.995) and good family communication (p < 0.003, OR = 1.023), and high self-efficacy (p = 0.001, OR = 1.558) were associated with higher fertility intentions. Influential factors in the lower age group (15-24 years) were mainly related to family and social support, in the 25-29 years age group they were more related to personal, family and social, while in the 30-39 years age group they were related to economic stability such as property and marital status.

CONCLUSIONS

The willingness to have a child is at a low to medium level among those of childbearing age who have not had children in China. There is a need to adopt a staggered policy for the younger age group to reduce perceived economic pressure, reduce occupational pressure on the age group, and increase childcare and occupational fertility friendly environments. In addition, there is a need for multisectoral economic compensation and educational district planning to alleviate the "don't want to save" and solve the "don't dare to give birth" problem. People who have had one child are more likely to want to have a second child, so the government and society need to do more to support the desire to have a child, thereby increasing the national fertility rate.

Decomposition and comparative analysis of urban-rural differences in eHealth literacy among nursing students: A multisite cross-sectional study

BACKGROUND

Investigating the urban-rural differences in eHealth literacy among Chinese nursing students is imperative for enhancing healthcare education and practice. This study aimed to investigate the factors that contribute to urban-rural differences in eHealth literacy among Chinese nursing students and measure their respective contributions.

DESIGN

A multisite cross-sectional study.

SETTINGS

In China.

PARTICIPANTS

A total of 967 nursing students were involved in this study.

METHODS

Multivariate linear regression models were used to explore the associations between sociodemographic and health-related factors and the eHealth literacy of Chinese nursing students. Additionally, Blinder-Oaxaca decomposition was employed to scrutinize the factors attributing to the urban-rural differences in eHealth literacy among Chinese nursing students, elucidating their respective contributions.

RESULTS

The mean eHealth literacy score for urban nursing students (mean: 20.26, SD: 3.61) exceeded that of rural nursing students (mean: 19.53, SD: 3.56) (p < 0.001). Blinder-Oaxaca decomposition analysis indicated that 84.82 % of the urban-rural differences in eHealth literacy among nursing students can be explained. The urban-rural differences are primarily explained by family health (40.05 %).

CONCLUSIONS

The study emphasizes the importance of tailoring educational curricula to address urban-rural differences in eHealth literacy among nursing students in China. Specifically, incorporating content related to family health in educational programs is crucial.

Revision of the emotion and motivation self-regulation questionnaire in Chinese middle school students

This study aims to revise the emotion and motivation self-regulation questionnaire(EMSR-Q) and test its validity among Chinese middle school students. A total of 780 middle school students were selected for item analysis based on the classical test theory (CTT) and multidimensional item response theory (MIRT) respectively and exploratory factor analysis. 615 middle school students were selected for confirmatory factor analysis and criterion validity test. The full sample was used for the reliability test. The results show that the Chinese version of EMSR-Q retains 19 items. The Pearson correlation coefficients and the corrected item-total correlation coefficients between each item and the total score of each dimension are greater than 0.4. The independent sample t-test for high and low groups was significant. The results of the confirmatory factor analysis support the second-order second-factor model of the English version of EMSR-Q. There are significant positive correlations between the dimension of the Chinese version of EMSR-Q and the dimensions of the relevant scale (p < 0.01). The internal consistency reliability coefficient ranged from 0.671 to 0.861 and the split-half reliability coefficients ranged from 0.726 to 0.809. The discrimination and difficulty of the 19 items are good, with the discrimination coefficients α of the items greater than 1.177 and the difficulty coefficient β range of the five options is within [-3,3]. The results show that the revised Chinese version of EMSR-Q indicators meets the psychometric requirements and can be used to measure the structure and characteristics of Chinese middle school students' emotion and motivation self-regulation. It can explore the possible influence of emotion and motivation self-regulation on academic development, which provides an important research tool for promoting the intervention research of emotion and motivation self-regulation, with a broad prospect of educational application.

Decomposition and comparative analysis of differences in anxiety between urban and rural Chinese adults: a national cross-sectional study

BACKGROUND

Anxiety is a severe global health problem. The long-established urban-rural dichotomy in China has led to unequal development in rural and urban areas, which may result in significant differences in the anxiety of rural and urban China. However, a comprehensive nationwide study exploring such disparities among Chinese adults remains lacking.

METHODS

The study extracted 27875 Chinese adults from the Psychology and Behaviour Investigation of Chinese Residents in 2022. The study utilized generalized linear regression analysis to explore the factors associated with Chinese adults' anxiety in urban and rural areas. Further, we used the Blinder-Oaxaca decomposition to analyze the role of explanatory factors in urban-rural disparities in anxiety among Chinese adults.

RESULTS

The median anxiety score among rural adults was 5.00 (P25: 1.00, P75: 7.00), surpassing that among urban adults, which was 4.00 (P25: 0.00, P75: 7.00) (P < 0.001). The generalized linear model showed that the differences in anxiety between rural and urban Chinese adults were reflected in intermittent fasting and marital status, career status, family per capita monthly income, age, and gender. The Blinder-Oaxaca decomposition revealed that 83.49% of the urban-rural disparities in anxiety among Chinese adults could be explained, and interpersonal network level was the most significant explanatory factor.

CONCLUSION

The prevalence of anxiety was higher in rural than in urban Chinese adults. The government should identify urban-rural disparities' explanatory factors to target precise intervention strategies, thereby narrowing the mental health differences between rural and urban.

Network of depression and anxiety symptoms in Chinese middle-aged and older people and its relationship with family health

OBJECTIVE

To examine the network structure of depression and anxiety symptoms and their association with Family Health among middle-aged and older people in China.

METHOD

This was a quantitative cross-sectional study, a total of 3,365 middle-aged and older people over 45 years were recruited, comprising 1,748 males and 1,617 females. Data were collected by using Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Short Form of the Family Health Scale.

RESULTS

The network structure of anxiety and depression symptoms was stable, and "Fatigue" and "Restlessness" were central symptoms and bridge symptoms. "Family, social or emotional health process" and "Family Healthy Lifestyle" exhibited a significant positive correlation, whereas "Family health resources" and "Suicide" demonstrated a significant negative correlation.

CONCLUSION

"Fatigue" and "Restlessness" are the targeted symptoms for preventing comorbid depression and anxiety symptoms among middle-aged and older adults, and the enhancement of "Family health resources" could be crucial for averting the onset of depression and anxiety symptoms within this demographic group.

The mediating role of sleep quality in the relationship between family health and depression or anxiety under varying living status

BACKGROUND

Existing research has examined the link between family health and mental health outcomes like depression and anxiety, but the mechanisms are unclear. Sleep quality may play a mediating role, and the effects of family health on mental health can differ based on living arrangements, which influence experiences and social support. This study aimed to investigate the mediating role of sleep quality in the relationship between family health and depression or anxiety across diverse living statuses.

METHODS

This cross-sectional study was conducted from June to September 2023 in five regions of China, including Guangdong Province, Guangxi Province, Jiangsu Province, Sichuan Province, and Macao Special Administrative Region. Family health was assessed using the Short Form of the Family Health Scale, while sleep quality was measured using the Self-Rating Scale of Sleep. Depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale. Mediation analysis was conducted to examine the mediating effect of sleep quality on the relationship between family health and mental health outcomes. Subgroup analyses were conducted to explore potential variations in the mediating role of sleep quality across different living status.

RESULTS

This study sample comprised 4918 participants, with a mean age of 30.1 years (SD = 12.6). The direct effect analysis demonstrated a significant negative correlation between family health and symptoms of depression (β = -0.216, p < 0.001) or anxiety (β = -0.199, p < 0.001). The mediation analysis results revealed that family health had a significant indirect effect on symptoms of depression (β = -0.040, p < 0.001) or anxiety (β = -0.050, p < 0.001) through sleep quality. Specifically, both the living with family group and the living in a shared accommodation group showed a significant mediation effect of sleep quality in the relationship between family health and mental health outcomes. However, the living alone group did not show a significant mediation role.

CONCLUSIONS

Sleep quality mediated the relationship between family health and symptoms of depression or anxiety, with significant effects in those living with family or in shared accommodations, but not those living alone. These findings underscore the importance of considering living status when examining mental health outcomes and developing interventions.

Decomposition and comparative analysis of urban-rural disparity in attitude towards advance care planning among Chinese adults: A nationwide study

BACKGROUND

Examining urban-rural disparity in Chinese adults' advance care planning (ACP) attitudes is crucial for healthcare decision-making. A comprehensive understanding of contributing factors, especially through decomposition and comparative analysis, remains limited.

METHODS

Data were derived from Psychology and Behavior Investigation of Chinese Residents (PBICR) including 19,738 participants, representative of Chinese adults. We constructed multivariate linear regression models to investigate the primary factors influencing the attitudes toward ACP among Chinese adults. Additionally, we employed Blinder-Oaxaca decomposition to analyze the factors contributing to the urban-rural disparities in ACP attitudes among Chinese adults and their respective contributions. The STROBE checklist was used in reporting this study.

RESULTS

The mean acceptance scores for ACP were 64.83 (standard deviation (SD) 25.83) among urban Chinese adults, significantly surpassing the scores observed in rural areas, which were 61.71 (SD 25.57) (p < 0.001). Blinder-Oaxaca decomposition analysis indicates that 98% of the urban-rural disparity in ACP attitudes among adults can be explained. This disparity is primarily associated with differences in household per capita monthly income (31.55%), health literacy (31.25%), education level (18.71%), age (-15.12%), family health (13.95%), perceived social support (10.48%), and self-efficacy (7.46%).

CONCLUSIONS

The findings suggest policymakers should enhance ACP education in rural areas to reduce disparities. Clinically, tailored ACP discussions and integration into routine care can improve acceptance, particularly in underserved regions.

The impact of family climate on problematic internet use: Findings from one nationwide study in China

BACKGROUND

With the growing attention paid to problematic internet use (PIU), this study aims to i) explore the prevalence of PIU based on a nationally representative sample and ii) propose and validate the theoretical model that correlates family climate with PIU.

METHODS

One national cross-sectional study was conducted with probability sampling and stratified sampling. Overall, 21,854 sample were included and analyzed. Validated measures of family climate, loneliness, and PIU was distributed and collected from June 2022 to August 2022.

RESULTS

The overall prevalence of PIU in the sample population is approximately 30.86 %. The model findings showed that family communication and family health had indirect effects of -0.12 and - 0.05 on PIU by the mediating effects of loneliness. The indirect effect explained 80.0 % of the total effect of family communication on PIU and 38.5 % of family health on PIU, highlighting the dominance effects of path family communication and PIU via loneliness. Extended family type (-0.047, p = 0.050), low family income (income≤3000 group, -0.127, p < 0.001) were identified as protective factors against PIU, while not living with family members (0.034, p = 0.021) was identified as risk factors of PIU.

LIMITATIONS

The nature of cross-sectional data have the limitation of preventing examining the casual relationships of PIU and the loneliness and family climate, in which future longitudinal study design is needed.

CONCLUSIONS

The high prevalence of PIU should be given adequate attention. Optimizing the family climate or family atmosphere by improving positive communication skills, providing family support and family health external resources can be served as effective strategies for controlling PIU.

The influence of family health on self-efficacy in patients with chronic diseases: the mediating role of perceived social support and the moderating role of health literacy

BACKGROUND

Chronic diseases are a global health challenge, and therefore, more attention should be paid to improving self-efficacy in people with chronic diseases. This study examined the relationship between family health and self-efficacy, and explored the mediating role of perceived social support and the moderating role of health literacy. The aim is to enhance the self-efficacy of chronic patients by improving family health, social support, and health literacy, thereby improving their physical and mental state.

METHODS

A cross-sectional study based on psychological and behavioural factors was conducted, namely, the 2022 China Residents Survey, which included 5150 Chinese patients with chronic diseases. The General Self-Efficacy Scale-Short Form was used to assess self-efficacy, the Health Literacy Questionnaire-short form was used to assess health literacy, the Perceived Social Support Scale-Short Form was used to evaluate perceived social support, and the Chinese version of the Family Health Scale-Short Form was used to assess family health status.

RESULTS

Family health of patients with chronic diseases had a significant positive effect on self-efficacy. Perceived social support was identified as a partial mediator between family health and self-efficacy, accounting for 59.39% of the total effect. Health literacy moderated the impact of family health on perceived social support and self-efficacy.

CONCLUSIONS

Chronic diseases have become a global health challenge, and more attention should be paid to improving the self-efficacy of the chronically ill population. Our results not only facilitate the understanding of the relationship mechanisms between family health and self-efficacy in chronic patients but can also serve as a guide for healthcare workers and policymakers who wish to provide better care for patients.

Study protocol: A national cross-sectional study on psychology and behavior investigation of Chinese residents in 2023

Introduction

This study protocol specifies the primary research line and theoretical framework of the 2023 Survey of the Psychology and Behavior of the Chinese Population. It aims to establish a consistent database of Chinese residents' psychological and behavioral surveys through multi-center and large-sample cross-sectional surveys to provide robust data support for developing research in related fields. It will track the public's physical and psychological health more comprehensively and systematically.

Methods

The study was conducted from June 20, 2023 to August 31, 2023, using stratified and quota sampling methods. A total of 150 cities across 800 communities/villages were surveyed, selected from China (Despite extensive coordination, we have been unable to contact our counterparts in the Taiwan region of China to obtain relevant statistical data). The questionnaires were distributed to the public one-on-one and face-to-face by trained surveyors. The questionnaires included basic information about the individual, personal health status, basic information about the family, the social environment in which the individual lives, psychological condition scales, behavioral level scales, other scales, and attitudes towards topical social issues. Supervisors conducted quality control during the distribution process and returned questionnaires, logically checked and cleaned for data analysis.

Discussion

Data collection has been finished, and scientific outputs based on this data will support the development of health promotion strategies in China and globally. In the aftermath of the pandemic, it will guide policymakers and healthcare organizations to improve their existing policies and services to maximize the physical and mental health of the Chinese population.

Trial Registration

This study was filed in the National Health Security Information Platform (Record No.: MR-37-23-017876) and officially registered in the China Clinical Trials Registry (Registration No.: ChiCTR2300072573).

Validation and structural exploration of the Chinese version of the Body Talk Scale

The Body Talk Scale (BTS) measures both negative body talk (including fat talk and muscle talk) and positive body talk across genders. In this study, we translated it into Chinese and assessed its structure, reliability and validity among mainland Chinese residents. Item analyses indicated that no item deletion was necessary for this study, and both exploratory factor analysis (n = 1853) and exploratory graph analysis (n = 1583) supported the three-factor structure of the original scale. Confirmatory factor analysis showed that the scale had a good model fit with CFI= 0.95, GFI= 0.93, TLI= 0.94, and RMSEA= 0.079(90 %CI [0.075, 0.084]). The results also showed that the Chinese version of the BTS had adequate criterion-related validity，internal consistency and six-week test-retest reliability. Meanwhile, the scale has good measurement invariance with respect to gender and can be tested for gender differences. In conclusion, the BTS showed sufficient psychometric properties in a Chinese sample, making it a valid instrument for studying body talk and health status in Chinese populations.

The prevalence of suboptimal health status among Chinese secondary school students and its relationship with family health: the mediating role of perceived stress and problematic internet use

BACKGROUND

The health status of secondary school students has received widespread attention, and family plays an extremely important role in protecting and promoting their health. However, the relationship between family health and suboptimal health status (SHS) among secondary school students and its underlying mechanisms are unclear. This study aims to understand the prevalence of SHS among Chinese secondary school students and analyze the relationship between family health and SHS, and examine the mediating roles of perceived stress and problematic internet use.

METHODS

The 2,094 secondary school students (52.6% boys, 47.4% girls, Mage ± SD = 15.74 ± 1.78) of this study came from "2022 Psychology and Behavior Investigation of Chinese Residents, PBICR". The chi-square test and t-test were used to analyze the prevalence of SHS in secondary school students with different characteristics. The SPSS PROCESS macro software was used to explore the relationship between family health and SHS and the mediating effects of perceived stress and problematic internet use.

RESULTS

The prevalence of SHS among Chinese secondary school students was 40.7%, and older students, girls, non-only child, high school students, smokers, drinkers, and students living in the Northeast region of China had higher prevalence. Family health, SHS, perceived stress, and problematic internet use were significantly related (P < 0.001). Family health had a negative effect on SHS (β = -0.127, 95% CI: -0.173 to -0.080). At the same time, perceived stress mediated the relationship between family health and SHS (chain mediation model 1: β = -0.109, 95% CI: -0.133 to -0.087; chain mediation model 2: β = -0.098, 95% CI: -0.120 to -0.078) and problematic internet use also mediated their relationship (chain mediation model 1: β = -0.034, 95% CI: -0.056 to -0.014; chain mediation model 2: β = -0.077, 95% CI: -0.099 to -0.055). The chain mediating effect of perceived stress and problematic internet use was also found in this study and the chain path from family health to perceived stress to problematic internet use to SHS was superior (β = -0.043, 95% CI: -0.054 to -0.033).

CONCLUSIONS

Many secondary school students are experiencing SHS. Improving family health, such as strengthening parent-child communication and fostering positive parenting practice, is critical to improving their health. Helping secondary school students relieve perceived stress and reduce their problematic internet use is key to implementing family-oriented health interventions.

The impact of health literacy on health-promoting lifestyle among community residents: the chain-mediating role of family health and physical activity

Background

Adopting health-promoting lifestyle (HPL) is crucial for improving overall well-being and reducing the risk of chronic diseases. The relationship between health literacy (HL) and HPL among Chinese community residents is complex, with potential mediating factors yet to be fully understood. Family health and physical activity (PA) may play significant roles in this relationship. This study aims to construct a chain mediation model to explore whether family health and PA mediate the effects of HL on HPL in Chinese community residents.

Methods

Using the convenient sampling method, 1,072 Chinese community residents were selected for a cross-sectional study. All participants completed a self-report questionnaire that collected demographic information, as well as data from the Health Literacy Scale Short-Form (HLS-SF12), Family Health Scale Short-Form (FHS-SF), Physical Activity Rating Scale (PARS-3), and Health Promoting Lifestyle Profile-II Revise (HPLP-II R). Data were analyzed using SPSS 26.0, with mediation analysis performed using the SPSS PROCESS macro.

Results

There were significant pairwise correlations between HL, family health, PA, and HPL (p < 0.01). HL was directly linked to HPL (effect = 0.442; SE = 0.025; 95% CI: 0.392, 0.491). Additionally, three indirect pathways were identified: family health independently mediated 6.02% of the effect (effect = 0.032; SE = 0.010; 95% CI: 0.013, 0.051), PA also independently mediated 9.02% of the effect (effect = 0.048; SE = 0.010; 95% CI: 0.030, 0.068), and a combined chain mediation through both family health and PA accounted for 1.88% of the effect (effect = 0.010; SE = 0.003; 95% CI: 0.005, 0.017).

Conclusion

HL not only has a direct impact on promoting HPL but also influences it indirectly through the mediating roles of family health and PA. These insights elucidate the mechanisms by which HL affects HPL, providing valuable theoretical guidance for the development and implementation of effective strategies to encourage healthy lifestyle practices.

Sequential multiple mediating effect of loneliness and family health on physical frailty and willingness to age at home in older adults: a national survey in China

BACKGROUND

With the rapid ageing of the global population, the number of older adults with physical frailty has been gradually increasing, making ageing at home a key strategy for coping with this demographic change. The opinions of older adults regarding their willingness to age at home deserve to be considered respectfully. As a result, this study aimed to investigate willingness to age at home and any associated underlying mechanisms involving physical frailty among older Chinese adults.

METHODS

This study was a national cross-sectional survey. Stratified random and quota sampling were used before and after the individual level respectively. Willingness to age at home was compared between older adults with different characteristics using the Mann-Whitney U test and Kruskal-Wallis H test. A Spearman rank test was conducted to explore the correlations among physical frailty, loneliness, family health, and willingness to age at home. The path hypothesis that loneliness and family health influence the relationship between physical frailty and willingness to age at home among older adults was further tested through sequential multiple mediation analysis.

RESULTS

A total of 3,837 older adults were included in this study. They returned a median score of 78 in terms of willingness to age at home. Physical frailty (β = - 0.044, P < 0.01) and loneliness (β = - 0.070, P < 0.001) were negatively associated, and family health (β = 0.275, P < 0.001) was positively associated with a willingness to age at home among older Chinese adults. Loneliness and family health played sequential multiple mediating role (β = - 0.018, Boot SE = 0.002, 95% CI = [-0.022, - 0.014]) between physical frailty and willingness to age at home.

CONCLUSIONS

Reducing physical frailty in older adults, reducing their sense of loneliness, and enhancing their family health is essential, as it can increase their levels of confidence with regard to ageing at home.

Examination of the psychometric properties of the short and long forms of the Family Health Scale in Turkish culture

PURPOSE

A healthy family is very important for community health. This study was conducted to test the validity and reliability of the short and long forms of the Family Health Scale (FHS) in Turkish culture.

DESIGN AND METHODS

This is a cross-cultural adaptation and validation of instruments using a methodological approach. A total of 783 individuals aged between 18 and 65 from Turkey. The test-retest reliability analysis of FHS was performed with 64 participants after four weeks.

RESULTS

Confirmed that the long form of the FHS was four-dimensional and the short form was one-dimensional. The results of the confirmatory factor analysis showed that the long and short forms fit well with the data, and it was determined that all fit indices were within acceptable limits. The Cronbach alpha of the long form of the FHS was 0.911, the cronbach alphas of the four sub-dimensions ranged from 0.833 to 0.908, and short form was 0.872. The pearson correlation coefficient between the forms was 0.919 (p = 0.000).

CONCLUSIONS

The results of the study revealed that the FHS is a valid and reliable measurement tool that can be used specifically for Turkish society.

PRACTICE IMPLICATIONS

Nurses can use both forms of the FHS to examine family health and trends in family health in the population they serve. The FHS may be an important screening tool in health care settings and family intervention programs. Nurses can use FHS when providing health care so that children grow up in a healthy family.

Factors associated with nursing students' mental health-related stigma: A multisite cross-sectional study

BACKGROUND

Mental health-related stigma remains a complex and pervasive issue globally. It not only inhibits individuals from seeking help but also influences the quality of healthcare they receive. Despite extensive research on mental health-related stigma, there is still limited understanding of factors influencing mental health-related stigma among nursing students.

OBJECTIVES

This study aimed to assess the level of mental health-related stigma among Chinese nursing students and investigate possible associated factors.

METHODS

Data were collected from the 2023 Psychology and Behavior Investigation of Chinese Residents (PBICR) survey. A total of 967 nursing students were included in the study. Multivariate stepwise linear regression analysis was conducted to examine the influencing factors of mental health stigma.

RESULTS

The mean mental health-related stigma score among nursing students was 15.31 ± 5.23 (range = 0-27). Perceived stress (β = 0.14, P = 0.001), self-efficacy (β = 0.22, P < 0.001), academic stage (β = 0.17, P < 0.001), depression (β = 0.15, P < 0.001), and adverse life events (β = 0.06, P = 0.044) were significantly associated with mental health-related stigma among nursing students (R2 = 0.147, adjusted R2 = 0.143, F = 33.214, P < 0.001).

CONCLUSIONS

Nursing students in China exhibit a moderate level of mental health-related stigma, suggesting room for improvement. Perceived stress, self-efficacy, academic stage, depression, and adverse life events emerged as significant influencing factors for mental health-related stigma. These findings provide valuable insights for developing interventions to reduce mental health-related stigma among nursing students, ultimately enhancing their well-being and preparing them for becoming competent healthcare professionals in the future.

The chain mediating role of family health and physical activity in the relationship between life satisfaction and health-promoting lifestyles among young adults in China

Background

Unhealthy lifestyles during adolescence are significant factors leading to chronic diseases in the future. Enhancing health-promoting lifestyles among young adults in China is crucial for preventing and reducing the risk factors of chronic diseases.

Objective

This study aims to explore the relationships between life satisfaction, family health, physical activity, and health-promoting lifestyles among young adults in China. It also seeks to confirm the chain mediation role of family health and physical activity in the influence of life satisfaction on health-promoting lifestyles in this population.

Methods

This study, conducted from August 2023 to November 2023, employed a random sampling method to recruit young adult participants aged 18-40 in the southwestern region of China. Variables were measured using the Satisfaction with Life Scale (SWLS), the Family Health Scale-Short Form (FHS-SF), the Physical Activity Rating Scale-3 (PARS-3), and the Health-Promoting Lifestyle Profile II Revised (HPLP-IIR). Data analysis was performed using SPSS 27.0 and the PROCESS macro version 4.1.

Results

The results indicated that life satisfaction was positively correlated with family health (r = 0.225), physical activity (r = 0.245), and health-promoting lifestyles (r = 0.506). Family health was positively correlated with physical activity (r = 0.320) and health-promoting lifestyles (r = 0.312). Physical activity was positively correlated with health-promoting lifestyles (r = 0.429). Additionally, life satisfaction could influence health-promoting lifestyles directly (effect = 0.369) and through three mediation pathways: (a) family health (effect = 0.033); (b) physical activity (effect = 0.050); (c) family health and physical activity (effect = 0.020).

Conclusion

This study supports the mediating role of family health and physical activity in the influence of life satisfaction on health behaviors among young adults in China. Therefore, we recommend that future public health initiatives place greater emphasis on family health and create conditions that facilitate physical activity for this group. This could be an important direction for further enhancing health-promoting lifestyles among young adults in China.

A predictive nomogram among hypertension old population from the community: A cross-sectional study

BACKGROUND

Frailty presents a significant challenge for aging adults, with a multitude of factors needing consideration. Despite this, there is a lack of research on predicting frailty in the old population with hypertension.

AIM

This study aims to create and validate a nomogram model for the old population with hypertension, to predict frailty and gain valuable insights into its prevalence and determinants.

METHOD

Data for this study were extracted from the "Psychology and Behavior Investigation of Chinese Residents (PBICR) in 2022 (PBICR-2022)", with information on frailty and related factors obtained through self-reported questionnaires. Frailty was assessed using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight (FRAIL) scale. The independent variables encompassed sociodemographic, physiological, psychological, and family health factors. A total of 1135 participants aged over 60 with hypertension were included in the study. Univariate and stepwise binary logistic regression analyses were conducted to identify the relationship between frailty and multiple risk factors and to establish the frailty risk prediction nomogram.

RESULTS

The prevalence of social frailty was found to be 30.91%. The final model included the degree of hypertension, history of falling in the past 3 months, Brief Illness Perception Questionnaire score, depression levels, and Family Health Scale score. The model exhibited good accuracy in the testing set, with an area under the ROC curve of 0.984 (95% CI: 0.978, 0.990).

CONCLUSION

These findings suggest that the prediction model effectively estimated the prevalence of frailty in the older population with hypertension from community and identified associated factors. The model demonstrated good performance and holds potential for further study on the management of frailty.

Acceptance level of advance care planning and its associated factors among the public: A nationwide survey

BACKGROUND

Advance care planning (ACP) can contribute to individuals making decisions about their healthcare preferences in advance of serious illness. Up to now, the acceptance level and associated factors of ACP among the public in China remain unclear. This study aims to investigate the acceptance level of ACP in China and identify factors associated with it based on the socioecological model.

METHODS

A total of 19,738 participants were included in this survey. We employed a random forest regression analysis to select factors derived from the socioecological model. Multivariate generalized linear model analysis was then conducted to explore the factors that were associated with the acceptance level of ACP.

RESULTS

On a scale ranging from 0 to 100, the median score for acceptance level of ACP was 64.00 (IQR: 48.00-83.00) points. The results of the multivariate generalized linear model analysis revealed that participants who scored higher on measures of openness and neuroticism personality traits, as well as those who had greater perceptions of social support, higher levels of health literacy, better neighborly relationships, family health, and family social status, were more likely to accept ACP. Conversely, participants who reported higher levels of subjective well-being and greater family communication levels demonstrated a lower likelihood of accepting ACP.

CONCLUSIONS

This study identified multiple factors associated with the acceptance level of ACP. The findings offer valuable insights that can inform the design and implementation of targeted interventions aimed at facilitating a good death and may have significant implications for the formulation of end-of-life care policies and practices in other countries facing similar challenges.

Social determinants of health and their relation to suboptimal health status in the context of 3PM: a latent profile analysis

Background

Suboptimal health is identified as a reversible phase occurring before chronic diseases manifest, emphasizing the significance of early detection and intervention in predictive, preventive, and personalized medicine (PPPM/3PM). While the biological and genetic factors associated with suboptimal health have received considerable attention, the influence of social determinants of health (SDH) remains relatively understudied. By comprehensively understanding the SDH influencing suboptimal health, healthcare providers can tailor interventions to address individual needs, improving health outcomes and facilitating the transition to optimal well-being. This study aimed to identify distinct profiles within SDH indicators and examine their association with suboptimal health status.

Method

This cross-sectional study was conducted from June 16 to September 23, 2023, in five regions of China. Various SDH indicators, such as family health, economic status, eHealth literacy, mental disorder, social support, health behavior, and sleep quality, were examined in this study. Latent profile analysis was employed to identify distinct profiles based on these SDH indicators. Logistic regression analysis by profile was used to investigate the association between these profiles and suboptimal health status.

Results

The analysis included 4918 individuals. Latent profile analysis revealed three distinct profiles (prevalence): the Adversely Burdened Vulnerability Group (37.6%), the Adversity-Driven Struggle Group (11.7%), and the Advantaged Resilience Group (50.7%). These profiles exhibited significant differences in suboptimal health status (p < 0.001). The Adversely Burdened Vulnerability Group had the highest risk of suboptimal health, followed by the Adversity-Driven Struggle Group, while the Advantaged Resilience Group had the lowest risk.

Conclusions and relevance

Distinct profiles based on SDH indicators are associated with suboptimal health status. Healthcare providers should integrate SDH assessment into routine clinical practice to customize interventions and address specific needs. This study reveals that the group with the highest risk of suboptimal health stands out as the youngest among all the groups, underscoring the critical importance of early intervention and targeted prevention strategies within the framework of 3PM. Tailored interventions for the Adversely Burdened Vulnerability Group should focus on economic opportunities, healthcare access, healthy food options, and social support. Leveraging their higher eHealth literacy and resourcefulness, interventions empower the Adversity-Driven Struggle Group. By addressing healthcare utilization, substance use, and social support, targeted interventions effectively reduce suboptimal health risks and improve well-being in vulnerable populations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-024-00365-5.

Status of self-medication and the relevant factors regarding drug efficacy and safety as important considerations among adolescents aged 12-18 in China: a cross-sectional study

The objective of this study was to investigate self-medication behavior among Chinese adolescents aged 12-18 years and explore the factors associated with whether adolescents prioritize drug efficacy or safety when engaging in self-medication behavior. In 2021, a questionnaire investigation was conducted in the Chinese mainland using a multi-stage sampling approach. After a statistical description, logistic regression was used to analyze the factors associated with considering drug efficacy and safety. The self-medication rate among Chinese adolescents aged 12-18 years was 96.61%. Of these, 65.84% considered drug safety to be essential, while 58.72% prioritized drug efficacy. Regression analysis showed that individuals with better healthcare were more likely to consider drug efficacy an important factor. Additionally, those with a healthier family lifestyle were more likely to prioritize efficacy. When individuals engage in self-medication, those residing in urban areas and possessing advanced preventive health literacy and ample family health resources tend to prioritize drug safety to a greater extent. Conversely, those with higher monthly household incomes and only children exhibit a decreased inclination towards prioritizing safety during self-medication. Self-medication is a frequently observed practice among Chinese adolescents aged 12-18. Several factors, such as demographic and sociological characteristics, health literacy, and family health status, have been found to be associated with the extent to which adolescents prioritize medication safety and efficacy when engaging in self-medication practices. Higher levels of health literacy and better family health status were positively correlated with considering both the efficacy and safety of drugs as important factors when self-medicating.

The effect of family health on suboptimal health status: The parallel mediation role of sleep quality and health behaviour

Background

The prevalence of suboptimal health status has been increasing worldwide, posing a significant challenge to public health. Meanwhile, family health has been recognised as an important factor influencing individual health outcomes. However, the mechanisms through which family health affects suboptimal health status remain unclear. We aimed to investigate the parallel mediation role of sleep quality and health behaviour in the relationship between family health and suboptimal health status.

Methods

We conducted a cross-sectional online survey with a sample of adults >18 years old from four provinces in China. The survey questionnaires queried their demographic characteristics, family health, suboptimal health status, sleep quality, and health behaviour. We assessed family health by the Family Health Scale-Short Form and suboptimal health status using the Suboptimal Health Status Questionnaire. We employed structural equation modelling to analyse the data and test the proposed mediation model.

Results

we collected 4918 valid questionnaires. The mean age of the participants was 30.1 years (standard deviation = 12.5). The correlation analysis demonstrated a significant negative association between family health and suboptimal health status (r = -0.44; P < 0.001). The results of the parallel mediation analysis showed that family health had a significant indirect effect on suboptimal health status through both sleep quality (β = -0.350; P < 0.001) and health behaviour (β = -0.137; P < 0.001). The total indirect effect of family health on suboptimal health status through both sleep quality and health behaviour was also significant (β = -0.569, P < 0.001).

Conclusions

This study highlights the significance of family health as a predictor of suboptimal health status and suggests that sleep quality and health behaviour are parallel mediators in this relationship. By understanding the role of family health, sleep quality, and health behaviour, interventions can be targeted to improve overall health outcomes.

Development of an optimal short form of the GAD-7 scale with cross-cultural generalizability based on Riskslim

Despite the relatively small number of items in the GAD-7, fewer items are increasingly sought to shorten testing time in large-scale mental health screenings. As a result, short forms based on the GAD-7, the GAD-2, and GAD-mini, have become popular. However, the GAD-2 and GAD-mini have reported lower diagnostic accuracy in some cultural contexts, implying that a validated short-form version of the GAD-7 may be lacking in large-scale cross-cultural anxiety screening. Based on this, to develop an optimal short form of the GAD-7 with cross-cultural stability, we utilized seven GAD-7 datasets from six different countries, totaling 47,484 participants. Five 2 to 6 item short forms of the GAD were constructed using the Riskslim machine learning algorithm. We evaluated the diagnostic accuracy of the GAD-7 short forms in the training and test sets based on the coefficient of determination(R2) and area under the curve(AUC) metrics, and the results showed that GAD-R2 performed poorly in some cultures, and all of the 3 to 6 item short forms of the GAD performed good in cross-cultural diagnostic rates, with the GAD-R6 showing the highest diagnostic accuracy in all cultures; GAD-R3 outperformed GAD-R2, GAD-2, and GAD-mini in all cultures; GAD-R3 had higher generalizability across cultures and special populations; Given that the GAD-R3 was shorter and nearly as accurate as the GAD-R6, we recommend the use of the GAD-R3 in clinical studies and epidemiologic investigations. And we recommend the optimal actual cutoff value of 15 for GAD-R3. Overall, we recommend GAD-R3 as the short-form version of GAD-7 in cross-cultural studies. However, the 2-item GAD scale is also optimal for the short-form version in clinical practice.

Research on factors influencing Chinese parents' support for death education: a cross-sectional survey

Objective

This study aims to explore the factors influencing Chinese parents' attitudes toward death education. Given the current lack of such education in China, this research is particularly significant. Death education is vital for shaping the values of young people and alleviating mental health issues, such as depression and suicidal tendencies. By identifying these influencing factors, this study seeks to provide guidance for policymakers and educators in promoting the development and widespread adoption of death education.

Methods

To do so, a national cross-sectional quota sample of 12,435 Chinese parents was used. Borrowing from social-ecological theory, the researchers carried out multiple stepwise regression analyses to examine the individual, family, and social-level factors that shape the supportive attitudes of Chinese parents toward death education.

Results

The findings revealed that at the individual level, parent (β = 0.04, p < 0.001), education level (β = 0.07, p < 0.001), and religious belief (β = -0.02, p < 0.05) were significant predictors of Chinese parents' support for death education. Meanwhile, at the family and social level, average monthly household income (β = 0.07, p < 0.001), family health (β = 0.03, p < 0.05), family communication (β = 0.02, p < 0.05), social support (β = 0.15, p < 0.001), neighborhood relations (β = 0.11, p < 0.001), and social network size (β = 0.05, p < 0.001) were significant predictors of Chinese parents' supportive attitudes toward death education.

Conclusion

Based on these findings, it is suggested that the relevant development, planning, publicity, and public welfare groups and government departments should promote death education, provide more social support, and encourage neighborhood harmony. As higher education and average monthly household income were found to significantly impact the support, the government should improve access to higher education and actively work to increase residents' income to facilitate the development of death education.

Media Use Behavior Mediates the Association Between Family Health and Intention to Use Mobile Health Devices Among Older Adults: Cross-Sectional Study

BACKGROUND

With the advent of a new era for health and medical treatment, characterized by the integration of mobile technology, a significant digital divide has surfaced, particularly in the engagement of older individuals with mobile health (mHealth). The health of a family is intricately connected to the well-being of its members, and the use of media plays a crucial role in facilitating mHealth care. Therefore, it is important to examine the mediating role of media use behavior in the connection between the family health of older individuals and their inclination to use mHealth devices.

OBJECTIVE

This study aims to investigate the impact of family health and media use behavior on the intention of older individuals to use mHealth devices in China. The study aims to delve into the intricate dynamics to determine whether media use behavior serves as a mediator in the relationship between family health and the intention to use mHealth devices among older adults. The ultimate goal is to offer well-founded and practical recommendations to assist older individuals in overcoming the digital divide.

METHODS

The study used data from 3712 individuals aged 60 and above, sourced from the 2022 Psychology and Behavior Investigation of Chinese Residents study. Linear regression models were used to assess the relationships between family health, media use behavior, and the intention to use mHealth devices. To investigate the mediating role of media use behavior, we used the Sobel-Goodman Mediation Test. This analysis focused on the connection between 4 dimensions of family health and the intention to use mHealth devices.

RESULTS

A positive correlation was observed among family health, media use behavior, and the intention to use mHealth devices (r=0.077-0.178, P<.001). Notably, media use behavior was identified as a partial mediator in the relationship between the overall score of family health and the intention to use mHealth devices, as indicated by the Sobel test (z=5.451, P<.001). Subgroup analysis further indicated that a complete mediating effect was observed specifically between family health resources and the intention to use mHealth devices in older individuals with varying education levels.

CONCLUSIONS

The study revealed the significance of family health and media use behavior in motivating older adults to adopt mHealth devices. Media use behavior was identified as a mediator in the connection between family health and the intention to use mHealth devices, with more intricate dynamics observed among older adults with lower education levels. Going forward, the critical role of home health resources must be maximized, such as initiatives to develop digital education tailored for older adults and the creation of media products specifically designed for them. These measures aim to alleviate technological challenges associated with using media devices among older adults, ultimately bolstering their inclination to adopt mHealth devices.

Socioecological influencers of health-promoting lifestyles in Chinese: a preliminary survey using convenient samples

Background

Healthy lifestyles are considered important means to reduce the burden of diseases. This cross-sectional study was conducted based on the Ecological Model of Health Behavior (EMHB) to analyze the factors associated with the health-promoting lifestyles of Chinese residents.

Methods

We carried out a cross-sectional investigation in July 2023. Our investigated factors included social-demographic characteristics (including sex, age, education level, employment status, marital status, personal monthly income, and daily behavioral habits [which were measured by a questionnaire)], health literacy [which was measured by the Chinese version of the Health Literacy Scale Short-Form scale (HLS-SF12)], and family health [which was measured by the Chinese version of the Short-Form of the Family Health Scale (FHS-SF)]. Our outcome was health promoting lifestyle, which was measured by a revised version of Health Promoting Lifestyle Profile-II (HPLP-IIR). Data were analyzed using stepwise regression.

Results

A total of 1,402 participants were enrolled. Higher scores of HLS-SF12 (β = 0.467), having regular exercise (β = 0.212), and regular physical examination (β = 0.088) were associated with better health-prompting lifestyles. However, older age (≥60 years) (β = -0.046), drinking (β = -0.066), and sleeping time (5-6 h/day) (β = -0.048) were associated lower levels of health-prompting lifestyles. Living with family (β = 0.077), FHS-SF (β = 0.104), and married (β = -0.077) were significant influencers. Unemployed (β = -0.048), receiving retirement pay (β = -0.053), and economic support provided by parents (β = 0.094) were associated with better health-prompting lifestyles. There were multiple influencing factors of the six dimensions of the HPLP-IIR. Our findings indicate that community residents with higher health literacy, better family health, and health-related behaviors tend to have better health-promoting lifestyles.

Conclusion

Our findings have confirmed the complex impacts of social-ecological factors on health-promoting lifestyles, which may help policy makers with health-promotion strategies making and also help researchers to control for confounding in study design.

[Cross-cultural adaptation and evidence of psychometric validity of the Family Health Scale for Brazilian Portuguese]

This study aimed to translate and cross-culturally adapt the Family Health Scale into Brazilian Portuguese and analyze evidence of its psychometric validity. The 32 items on family health were cross-culturally adapted, using the content validity index to calculate semantic, idiomatic, cultural, and conceptual characteristics of the scale and its items. A pre-test to identify evidence of validity was applied to 40 families. At another time, the instrument was applied to 354 families in a Brazilian northeastern city. The index of agreement between the raters ranged from 0.84 for the scale items to 0.98 for the total scale, according to Kendall's coefficient. According to Cronbach's alpha, evidence of psychometric validity is adequate. Most families had a moderate degree of health, according to the scale. Therefore, the Brazilian version of the Family Health Scale showed conceptual, semantic, cultural, and operational equivalence with the original items, along with satisfactory psychometric properties for use among the Brazilian population with effectiveness and safety.

Subjective dry eye symptoms and associated factors among the national general population in China during the COVID-19 pandemic: A network analysis

Background

The coronavirus disease 2019 (COVID-19) pandemic has presented numerous challenges to public health, including the emergence of subjective dry eye symptoms among individuals. However, there is currently a dearth of comprehensive knowledge regarding the associated factors with subjective dry eye symptoms in the general population.

Methods

A nationwide survey in China was carried out from 20 June to 31 August 2022, involving 21 916 participants. Subjective dry eye symptoms were assessed using the Ocular Surface Disease Index-6. We employed random forest classification to select potential associated factors based on the socioecological model. We also conducted univariate and multivariable logistic regression analyses to explore the factors associated with subjective dry eye symptoms. Network analyses were employed to explore the network structure of subjective dry eye symptoms and associated factors.

Results

The item "watching TV (or similar task)" displayed the highest node strength and exhibited the highest predictability within the network. The results of the multivariate logistic regression analysis demonstrated significant associations between subjective dry eye symptoms and several factors, including loneliness (odds ratio (OR) = 1.29; 95% confidence interval (CI) = 1.26 to 1.32), problematic Internet use (OR = 1.08; 95% CI = 1.08 to 1.09), family communication (OR = 1.01; 95% CI = 1.00 to 1.01), the presence of depression (OR = 1.53; 95% CI = 1.39 to 1.68) and anxiety (OR = 1.31; 95% CI = 1.17 to 1.47) symptoms, older age (OR = 1.01; 95% CI = 1.01 to 1.01), self-rated health status (OR = 0.99; 95% CI = 0.98 to 0.99), family health (OR = 0.97; 95% CI = 0.96 to 0.97), health literacy (OR = 0.98; 95% CI = 0.97 to 0.99) and the agreeableness personality trait (OR = 0.97; 95% CI = 0.95 to 0.99).

Conclusions

These findings have important implications for public health interventions targeting the prevention and management of subjective dry eye symptoms in the general population. Strategies addressing individual risk factors and supporting psychological well-being may prove beneficial in mitigating the burden associated with subjective dry eye symptoms.

Development and validation of a short-form suboptimal health status questionnaire

Background

Suboptimal health status (SHS) is a reversible, borderline state between optimal health and disease. Although this condition's definition is widely understood, related questionnaires must be developed to identify individuals with SHS in various populations relative to predictive, preventive, and personalized medicine (PPPM/3PM). This study presents a short-form suboptimal health status questionnaire (SHSQ-SF) that appears to possess sufficient reliability and validity to assess SHS in large-scale populations.

Methods

A total of 6183 participants enrolled from Southern China constituted a training set, while 4113 participants from Northern China constituted an external validation set. The SHSQ-SF includes nine key items from the Suboptimal Health Status Questionnaire-25 (SHSQ-25), an instrument that has been applied to Africans, Asians, and Caucasians. Item analysis and reliability and validity tests were carried out to validate the SHSQ-SF. The receiver operating characteristic (ROC) curve was used to identify an optimal cutoff value for SHS diagnosis, by which the area under the curve (AUC) and 95% confidence interval (CI) were determined.

Results

Cronbach's α coefficient for the training dataset was 0.902; the split-half reliability was 0.863. The Kaiser-Meyer-Olkin (KMO) value was 0.880, and Bartlett's test of sphericity was significant (χ2 = 32,929.680, p < 0.05). Both Kaiser's criteria (eigenvalues > 1) and the scree plot revealed one factor explaining 57.008% of the total variance. Standardized factor loadings for the confirmatory factor analysis (CFA) indices ranged between 0.58 and 0.74, with χ2/dƒ = 4.972, GFI = 0.996, CFI = 0.996, RFI = 0.989, and RMSEA = 0.031. The AUC was equal to 0.985 (95% CI: 0.983-0.988) for the training dataset. A cutoff value (≥ 11) was then identified for SHS diagnosis. The SHSQ-SF showed good discriminatory power for the external validation dataset (AUC = 0.975, 95% CI: 0.971-0.979) with a sensitivity of 96.2% and a specificity of 87.4%.

Conclusions

We developed a short form of the SHS questionnaire that demonstrated sound reliability and validity when assessing SHS in Chinese residents. From a PPPM/3PM perspective, the SHSQ-SF is recommended for the rapid screening of individuals with SHS in large-scale populations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-023-00339-z.

The Association Between Family Health and Frailty With the Mediation Role of Health Literacy and Health Behavior Among Older Adults in China: Nationwide Cross-Sectional Study

BACKGROUND

Family health develops from the intersection of the health of each family member and their interactions and capacities as well as the family's internal and external resources. Frailty is the most prominent and typical clinical manifestation during population aging. Family health may be effective in addressing frailty, and this association may be mediated by health literacy and health behaviors. Until now, it is unclear whether and how family health affects frailty in older adults.

OBJECTIVE

This study aimed to examine the associations between family health and frailty and the mediation roles of health literacy and health behaviors.

METHODS

A total of 3758 participants aged ≥60 years were recruited from a national survey conducted in 2022 in China for this cross-sectional study. Family health was measured using the Short Form of the Family Health Scale. Frailty was measured using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale. Potential mediators included health literacy and health behaviors (not smoking, not having alcohol intake, physical exercise for ≥150 minutes per week, longer sleep duration, and having breakfast every day). Ordered logistic regression was applied to explore the association between family health and frailty status. Mediation analysis based on Sobel tests was used to analyze the indirect effects mediated by health literacy and behaviors, and the Karlson-Holm-Breen method was used to composite the indirect effects.

RESULTS

Ordered logistic regression showed that family health is negatively associated with frailty (odds ratio 0.94, 95% CI 0.93-0.96) with covariates and potential mediators controlled. This association was mediated by health literacy (8.04%), not smoking (1.96%), longer sleep duration (5.74%), and having breakfast every day (10.98%) through the Karlson-Holm-Breen composition.

CONCLUSIONS

Family health can be an important intervention target that appears to be negatively linked to frailty in Chinese older adults. Improving family health can be effective in promoting healthier lifestyles; improving health literacy; and delaying, managing, and reversing frailty.

Exploring the Link between Family Health and Health Literacy among College Students: The Mediating Role of Psychological Resilience

Enhancing health literacy is of the utmost importance to enhance the physical and mental well-being of college students. Unfortunately, there has been limited research investigating the means of improving college students' health literacy through the perspective of families. Family health is an interdisciplinary and complex concept that involves multiple factors, and it provides a holistic perspective on the overall well-being of the family unit. Thus, this study aims to examine the relationship between family health and health literacy and scrutinize the mediating role of psychological resilience. A valid sample of 5473 students was collected from a university in November-December 2022 and was assessed using regression analysis. The findings reveal that family health has a positive association with the health literacy of college students (β = 0.56, p < 0.001), with psychological resilience playing a critical mediating role (β = 0.11, 95% CI: [0.09, 0.13]). Therefore, the family ought to be recognized as a fundamental mechanism to enhance college students' health literacy. Additionally, it is essential to emphasize the amelioration of psychological distress among college students and enhance their psychological resilience, which will be helpful for their overall health consciousness and proficiency.

The multiple mediating effect of family health and perceived social support on depressive symptoms in older adults: A cross-sectional national survey in China

BACKGROUND

Depression harms older adults' physical health and quality of life, especially for those with disabilities. This study aims to investigate the epidemiological characteristics of depressive symptoms in older adults and influencing factors involving neuroticism in China.

METHODS

A multistage random sampling method was adopted to recruit older adults. We conducted a multiple mediating analysis to explore how overall family health and perceived social support affect the relationship between neuroticism and depressive symptoms in older adults.

RESULTS

A total of 1122 older adults were included in this study, and 529 individuals reported suffering from depressive symptoms (47.1 %). Mediation analysis results indicated that neuroticism had a direct predictive effect on depressive symptoms in older adults. Family health and perceived social support partly mediated the relationship between neuroticism and depressive symptoms in older adults. Moreover, depressive symptoms in older adults with high neuroticism was directly affected by decreasing family health and indirectly and cumulatively aggravated by the mediation of lower perceived social support.

LIMITATIONS

The cross-sectional study design limits the conclusion about causation and directionality.

CONCLUSIONS

Family health and perceived social support can prevent depressive symptoms in older adults with high neuroticism.

Factors Associated with Willingness toward Organ Donation in China: A Nationwide Cross-Sectional Analysis Using a Social–Ecological Framework

Improving public willingness toward organ donation is an important solution to the low organ donation rate. This study aimed to explore factors impacting public willingness for organ donation in China from a multi-agent perspective and further explore the impact of these factors on high or low willingness, using a social–ecological framework. Data from a total of 11,028 (effective rate, 94.18%) participants were analysed. Generalised linear model (GLM) and quantile regression were used to explore factors associated with willingness and high/low willingness toward organ donation, respectively. The mean willingness toward organ donation was 56.9 (range, 0–100) points. GLM regression revealed that age, family health, males, lower educational levels, and agricultural hukou were negatively associated with willingness. For personality, conscientiousness was negatively associated with willingness, whereas openness was positively associated with willingness. Health literacy perceived social support, and media utilisation were positively associated with willingness. Quantile regression further indicated that educational levels of college, bachelor, master’s, and PhD, openness, health literacy, perceived social support, and media utilisation were positively associated with organ donation willingness at all percentiles. It is necessary to adopt more targeted and diversified publicity, education, and guidance for different types of individuals. Meanwhile, social support needs to be strengthened. To enhance the willingness of the residents to donate organs, media publicity should be strengthened, particularly by using modern ways to improve their health literacy.

Reliability and validity of the Chinese version of the Sakata Eating Behavior Scale short form and preliminary analysis of the factors related to the score of the scale

Background

The obesity rate in the Chinese population is increasing and there is a lack of short and reliable scales for measuring obesity-related eating behavior in China. The EBS-SF (Sakata Eating Behavior Scale short form) has only 7 entries and has shown good reliability in studies such as those in Japan.

Objective

To translate the EBS-SF into Chinese, check its reliability, validity and explore the related factors.

Method

The EBS-SF was translated into Chinese. 3,440 residents were investigated and 34 respondents were retested. Item analysis and reliability and validity tests were carried out. Personality characteristics, family health status and depression were investigated using the BFI-10, FHS-SF and PHQ-9 to investigate the factors associated with EBS-SF. The t-test, ANOVA and Pearson correlation was used to explore the related factors of its scores.

Result

Among 3,440 residents, 1,748 (50.81%) were male and 1,692 (49.19%) were female; 1,373 (39.91%) were aged 36–50 years. All 7 items were qualified in the item analysis. As for reliability, the Cronbach's α was 0.870, the split-half reliability was 0.830, the test-retest correlation coefficient was 0.868. As for the structural validity, the standardized factor loadings were above 0.50, χ2 / df = 2.081,GFI = 0.999; NFI = 0.999; RFI = 0.996; RMSEA = 0.018, all qualified. The characteristics, personality, family health and depression were correlated with the score of the Chinese version of EBS short form.

Conclusion

The structural validity and reliability of the Chinese version of the EBS-SF are good and it can be used as a measurement tool to evaluate the eating behavior of Chinese. The scores of the EBS-SF may be related to the sociological characteristics, personality, family health, and depression status.

A national cross-sectional study on the influencing factors of low HPV vaccination coverage in mainland China

Background

HPV vaccine can block the infection of high-risk human papillomavirus and is an important measure to effectively reduce the incidence of cervical cancer and precancerous lesions. However, the HPV vaccination rate is still low in China. There are many factors. Therefore, it is important to study the influencing factors to provide basis for promoting the formulation of vaccination strategies.

Methods

This study used a multi-stage sampling method to conduct a face-to-face questionnaire survey on women in different regions of China. The new general self-efficacy scale was used to measure the self-efficacy of the respondents. The short form of family health scale measured their family health. The t-test and binary Logistic regression analysis were used to screen the influencing factors of HPV vaccination. Restricted cubic spline model was used to analyze the influence trend of self-efficacy and family health on HPV vaccination rate.

Results

(1) The HPV vaccination rate was low, especially in the ≤18 group. The place of residence, capita household income/month, individual self-efficacy and family health had a significant impact on HPV vaccination. (2) The restricted cubic spline model showed that self-efficacy positively promoted HPV vaccination, the correlation strength was statistically significant (χ2 =27.64, P<0.001) and non-linear (χ2 = 12.49, P = 0.0004); The poor family health hindered HPV vaccination, and the association strength was statistically significant (χ2 = 47.81, P < 0.001) and non-linear (χ2 = 9.96, P = 0.0016).

Conclusion

It is necessary to strengthen the health education of HPV vaccination knowledge in the population to eliminate the hesitancy of vaccination. Free HPV vaccination strategies should be developed and encourage people of appropriate age to receive as early as possible. Self-efficacy and family health should be enhanced to increase HPV vaccination rate, so as to achieve the goal of reducing the incidence of cervical cancer and protecting women's health.

Can smartphone use affect chronic disease self-management among Chinese middle-aged and older adults? A moderated mediation model

Introduction

Chronic disease self-management is influenced by many factors. Previous studies have linked patients' media use with chronic disease self-management, but the underlying mechanisms of this relationship are less understood.

Objectives

The purpose of this study is to explore the mediating role of family health (FH) between frequency of smartphone use (FOSU) and self-management behaviors among middle-aged and older patients with chronic diseases (SBAMAOPWCD) through a moderated mediation model, and whether this indirect relationship is modified by the solitary status of middle-aged and older Chinese patients with chronic disease.

Methods

Surveys were collected from 1,424 (N = 1,424; age > 45) middle-aged and older with one or more chronic conditions in China on self-reports of FOSU, FH and Chronic disease self-management behaviors were used to examine the moderated mediation model.

Results

The results showed that the FOSU was significantly and positively associated with SBAMAOPWCD (β = 0.220, p < 0.001; β = 0.170, p < 0.001; β = 0.167, p < 0.001; β = 0.158, p < 0.001); The Family health resources (FHR) dimension of FH and the Family external social supports (FESS) dimension mediated the relationship between the FOSU and SBAMAOPWCD (β = -0.0758, CI: -0.1402, -0.0236; β = 0.0721, CI: 0.0141, 0.1458), Among them, the FHR dimension mediated mainly among FOSU, exercise and cognitive symptom management practices (CSMP; β = -0.0344, CI: -0.0652, -0.0102; β = -0.0401, CI: -0.0725, -0.0138), the FESS dimension of the FH mediated the relationship between the FOSU and communication with physicians (CWP; β = 0.0376, CI: 0.0116, 0.0705); Solitary state played a moderating role in the relationship between FHR dimension and SBAMAOPWCD (live alone β = -0.2395, CI: -0.4574, -0.0661; not live-alone β = -0.0599, CI: -0.1164, -0.0172). In addition, solitary state played a moderating role in the relationship among FHR dimension and CSMP for middle-aged and older patients (live alone β = -0.1095, CI: -0.1961, -0.0378; not live-alone β = -0.0334, CI: -0.0633, -0.0102). Interestingly, the relationship between FESS dimension and SBAMAOPWCD was moderated only by the non-live alone population (β = 0.0676, CI: 0.0008, 0.1478), and not by the live-alone population (β = 0.1026, CI: -0.1061, 0.3278).Unexpectedly, we found that when their FHR were lower, they reported higher levels of chronic disease self-management, middle-aged and older patients with chronic diseases who live alone are more significant in this impact relationship.

Conclusions

The study further deepens our understanding of the mechanisms linking frequency of smartphone use with chronic disease self-management behaviors, and it helps to develop interventions to improve chronic disease self-management behaviors in middle-aged and older adults.

The Role of Family Health in Mediating the Association between Smartphone Use and Health Risk Behaviors among Chinese Adolescent Students: A National Cross-Sectional Study

The direct impact of smartphones on health risk behaviors of adolescent students has been verified. However, the mediating mechanisms that underly this relationship remain largely unknown. Therefore, the aim of the study is to explore the role of family health in mediating the relationship between the frequency of smartphone use and adolescent students' health risk behaviors. A questionnaire was used to collect cross-sectional data from 693 adolescent students aged 12-18 in China and a structural equation model was analyzed. Among the nine health risk behaviors, the most frequent health risk behaviors in Chinese adolescent students were non-compliance walking behaviors (M=Mean; SD = Standard deviation) (M ± SD) (2.78 ± 1.747), eating unhygienic food (M ± SD) (2.23 ± 1.299), being subjected to physical violence (M ± SD) (2.19 ± 0.645), and leaving home (M ± SD) (2.13 ± 0.557). The SEM results showed that the adolescent students' smartphone use had a positive impact on delaying the age of first alcohol consumption (β = 0.167, CI:0.067 0.287) and a negative impact on the non-compliance walking behaviors (β = 0.176, CI:0.011 0.266). Family health plays an indirect-only mediated role (the proportions of indirect-only mediated roles are 11.2%, 12.4%, and 11.5%) in the relationship between smartphone use and adolescent students' partial health risk behaviors: (CI: -0.042 -0.002), (CI: -0.049 -0.005), and (CI: -0.043 -0.002). These findings provided a theoretical and practical basis for better interventions in adolescent health risk behaviors.