Chen JH, Chen MF, Zain NM, Yap CY, Yusuf A, Ying BH. Family function and health self-management ability among older adults from mountainous areas in China: moderated mediation model in a cross-sectional study.
BMC Public Health 2025;
25:1291. [PMID:
40188096 PMCID:
PMC11972470 DOI:
10.1186/s12889-025-22472-2]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/24/2025] [Indexed: 04/07/2025] Open
Abstract
BACKGROUND
Improving the health self-management ability (HSMA) of older adults is a feasible strategy for addressing population ageing and the high incidence of non-communicable diseases. Identifying psychosocial factors that facilitate better self-management of health is key to developing effective interventions. This study explored whether self-efficacy mediates the relationship between family function and HSMA and whether this mediation is moderated by personal income.
METHODS
A multicentre cross-sectional survey was conducted with 596 participants (response rate of 97.2%) in the mountainous Lishui region of China by using a multi-stage, stratified, cluster-sampling procedure. The survey included questions on sociodemographic characteristics, the Adult Health Self-Management Skills (Ability) Rating scale, family APGAR scale and General Self-Efficacy (GSE) scale. Data were analysed using descriptive statistics, Spearman's correlation, and multiple regression analysis with mediation and moderated mediation models.
RESULTS
The average score for HSMA, family function, and GSE were 149.6 ± 18.1 (out of 190), 8.2 ± 2.2 (out of 10), and 24.0 ± 6.0 (out of 40), respectively, which indicate moderate HSMA and family function levels and low GSE among older adults in Lishui. Significant correlations were observed between family function and GSE (rs = 0.150, P < 0.001), GSE and HSMA (rs = 0.336, P < 0.001), and family function and HSMA (rs = 0.297, P < 0.001). The mediation model explained 21.5% of the variance in HSMA, with significant total (c: B = 0.343, P < 0.001) and indirect effects (ab: B = 0.0505, 95% CI = [0.0227, 0.0830]). The indirect effects (family function → GSE → HSMA) decreased with decreasing income (high income, B = 0.0497; middle income, B = 0.0353; low income, B = 0.0233), while the direct effect (family function → HSMA) increased with decreasing income (high income, B = 0.189; middle income, B = 0.270; low income, B = 0.350).
CONCLUSION
HSMA, APGAR score and GSE score were positively related among older adults in the Lishui region, highlighting potential areas for improvement. The results clarify the mediating effect of GSE on the relationship between family function and HSMA along with the moderating role of personal income. Strengthening family function may enhance HSMA, especially in low income older adults, while boosting GSE may benefit those with higher incomes. Future longitudinal studies should confirm these relationships and their causal direction.
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