The average score for (HSMA) among older adults in Lishui was 149.6 ± 18.1 (out of 190).
Moderate levels of HSMA and were observed, with low levels of (GSE).
Significant correlations exist between family function and GSE, GSE and HSMA, and family function and HSMA.
The mediation model explained 21.5% of the variance in HSMA, indicating a significant relationship between family function, GSE, and HSMA.
Indirect effects of family function on HSMA through GSE were found to decrease with lower income levels.
Direct effects of family function on HSMA increased as personal income decreased.
Simplified
BACKGROUND: Improving the (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 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 (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 (r = 0.150, P < 0.001), GSE and HSMA (r = 0.336, P < 0.001), and family function and HSMA (r = 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). s s s
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.
Key numbers
97.2%
Response Rate
Percentage of participants who completed the survey out of those enrolled.
596
Participants
Total number of older adults surveyed in the study.
149.6 ± 18.1
Average Score
Mean score on the Adult Health Self-Management Skills Rating Scale.
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Declarations. Ethics approval and consent to participate: This study was approved by the Research Ethics Review Committee of Lishui University (No. 2023YD001). All methods were carried out under relevant guidelines and conducted in accordance with the Declaration of Helsinki. All participants took part in this study voluntarily, covered by informed consent, and gave their written consent. Consent for publication: No application. Competing interests: The authors declare no competing interests.
