The impact of perceived social support on chronic disease self-management among older inpatients in China: The chain-mediating roles of psychological resilience and health empowerment

Apr 26, 2025BMC geriatrics

How Feeling Supported Affects Chronic Disease Care in Older Hospital Patients in China Through Mental Strength and Health Confidence

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Abstract

Perceived social support explained 45.7% of the variance in among 368 older inpatients.

Perceived social support had a direct positive impact on chronic disease self-management.
was identified as a significant mediator in the relationship between perceived social support and chronic disease self-management.
also served as an independent mediator for the impact of perceived social support on chronic disease self-management.
A chain mediation effect was observed, linking psychological resilience and health empowerment in their influence on chronic disease self-management.

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BACKGROUND: is a critical concern in public health, in which perceived social support plays an important role. However, the underlying pathways and mechanisms linking perceived social support to chronic disease self-management remained unclear. This study investigated whether and mediated the relationship between perceived social support and the effectiveness of chronic disease self-management.

METHODS: A total of 368 older inpatients with chronic non-communicable diseases were recruited from three grade-A tertiary hospitals in Changsha City, China, using a convenience sampling method between January and June 2023. Data were collected using the General Information Questionnaire, the Chronic Disease Self-Management Scale, the Perceived Social Support Scale, the Connor-Davidson Resilience Scale, and the Health Empowerment Scale. Descriptive demographic analysis and Pearson correlation analysis were conducted using SPSS 26.0, and model 6 in the macro program Process 4.1 was employed to test the chain mediation effect.

RESULTS: Most older inpatients were aged 60-69 years (52.2%), followed by those aged 70-79 years (30.7%). Regression analysis revealed that perceived social support, psychological resilience, and health empowerment collectively explained 45.7% of the variance in chronic disease self-management. Mediation analysis demonstrated that perceived social support not only had a direct positive impact on chronic disease self-management (effect = 0.141, 95% CI: LL = 0.041, UL = 0.241), but also indirectly affected chronic disease self-management through three significant mediating pathways: the independent mediating effect of psychological resilience (effect = 0.102, 95% CI: LL = 0.061, UL = 0.155), the independent mediating effect of health empowerment (effect = 0.042, 95% CI: LL = 0.010, UL = 0.080), and the chain mediating effect between psychological resilience and health empowerment (effect = 0.024, 95% CI: LL = 0.006, UL = 0.047).

CONCLUSION: Perceived social support influenced chronic disease self-management directly and indirectly through psychological resilience and health empowerment. These findings offered practical guidance for developing more effective intervention strategies aimed at improving chronic disease self-management among older inpatients.

Key numbers

0.141

Direct Effect on Self-Management

Effect size of perceived social support on .

45.7%

Variance Explained

Percentage of variance in explained by the three factors.

0.102

Indirect Effect via Resilience

Effect size of perceived social support on self-management through .

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The impact of perceived social support on chronic disease self-management among older inpatients in China: The chain-mediating roles of psychological resilience and health empowerment

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