Perceived Health Competence and Health Education Experience Predict Health Promoting Behaviors in Rural Elderly: A Cross-Sectional Study | BMC Public Health

Study design and participants

This study was a multicenter cross-sectional survey conducted in Nanbu County, Sichuan Province, China. Residents living in a rural community who: were 60 years of age or older; resided in selected villages; had resided there for at least 1 year prior to the date of the survey; were able to understand and answer the questions of the questionnaire were invited to participate in the study. Those who lived in selected villages but were housed in nursing homes or did not wish to participate in the study were excluded.

Sampling

We used a multi-stage stratified cluster sampling procedure, which took into account geographic region and economic development status. In Stage 1, Nanbu County, Sichuan Province, China was selected. Sichuan Province can be classified as an economically developed area in western China and plays an important role in the overall development of the country. Nanbu County, located in the northeast of Sichuan Province, is a typical area with significant aging of the elderly population, higher than the national and Sichuan average (Table 1), and the phenomenon of population aging rural in the country of Nanbu is larger than that of the urban population. Therefore, Nanbu country, Sichuan province was selected as the sampling region. The socio-economic characteristics of the sample area are shown in Table 1. Nanbu County has 38 townships and 363 administrative villages, each village has nearly 10 village groups and about 200 households. In step 2, five townships were randomly selected from 38 townships. In step 3, an administrative village was randomly selected from each selected township. In sage 4, three village groups were randomly selected from each selected administrative village. Finally, we selected all eligible individuals in the 15 village clusters as the sample population for this study.

Table 1 Socio-economic characteristics of the sample region in 2020

Measures

All participants completed four paper questionnaires: Demographics and Health Care Status Survey, Chinese version of the Healthy Lifestyle Profile-II (HPLP-II), Perceived Competence Scale in Health (PHC) and the Lubben Social Network Scale.

Survey of socio-demographic characteristics and health status

Socio-demographic characteristics, including gender, age, education level, marital status, monthly household income per capita, proportion of people living alone, smoking and drinking, were studied. The questionnaire also covered the following points: regular physical examination and experience of health education activities. These indicators were measured by the following questions: Have you had a regular physical examination in the past year? Did you participate in any health education activities prior to this survey? For each question, response options included “yes” and “no”.

The Chinese version of the Healthy Lifestyle Profile-II (C-HPLP-II)

The Healthy Lifestyle-II Profile Developed by Walker [19]translated and validated by Cao [20], was used to assess health-promoting behaviors. The C-HPLP-II consists of 6 dimensions with a total of 40 items: interpersonal relationship (5 items), responsibility for health (11 items), stress management (5 items), diet (6 items), physical activity (8 items), spiritual growth (5 items). Each item is rated on a four-point Likert scale ranging from 1 (not at all) to 4 (always). The mean score was calculated with a higher score indicating higher levels of engagement in health promoting behaviors. The original scale had a Cronbach’s α coefficient of 0.94 at the time of its development. The Cronbach’s α coefficient of the scale in this study was 0.907.

The Chinese version of the Perceived Health Competence Scale (C-PHC)

The Smith Perceived Health Competency (PHC) Scale [17]translated and validated by Liang [12], was used to assess perceived health competence. The C-PHC consists of 8 items on a five-point Likert scale. Respondents were asked how much they agreed with each item with a range of 1 (strongly disagree) to 5 (strongly agree). The mean score was calculated with a higher score indicating higher perceived health competence. The original scale had a Cronbach’s α coefficient of 0.90 at the time of its development. The Cronbach’s α coefficient of the scale in this study was 0.893.

The Chinese version of the Lubben Social Network Scale (C-LSNS)

The Lubben Social Network Scale (LSNS) by Lubben [21]translated and validated by Qi [22], was used to assess older people’s credible relationships with family/relatives and friends and the support they can get from them. The C-LSNS consists of 12 elements. The score for each item ranges from 0 to 5, with a total score of 0 to 60. The higher the score, the richer the respondent’s social network. The Cronbach’s α coefficient of the scale in this study was 0.792.

Data collection procedures

For data collection, the researchers informed the leaders of the selected village groups of the purpose of this study and obtained permission to conduct research in these locations. In this study, 3 researchers and 9 research assistants formed three survey teams. Each team, made up of a researcher and three assistants, was in charge of collecting data from a village group. All research assistants were senior nursing students. For inter-rater reliability, survey teams were trained by the principal investigator on questionnaire content and survey techniques. The investigators then visited selected village groups and identified potential participants interested in participating by conducting home visits. They were selected for their eligibility to participate, and if they were eligible to participate, the purpose and procedures of the study were explained to them. After obtaining written consent, a face-to-face interview was conducted using structured questionnaires. Participants completed the questionnaire themselves with a pen if they were able. The completed questionnaires were then reviewed and collected by the interviewers. For participants with literacy difficulties, mobility issues, or poor vision, an interviewer read the questions aloud and recorded the participants’ responses to the questions. Data was collected from July to August 2021. In total, approximately 700 seniors were visited, of whom 273 were excluded from the study due to severe cognitive or communication impairments (not= 81), refusal to participate in this study (not= 186), or local residence of less than one year (not= 6). The remaining 427 seniors who met the inclusion criteria were investigated. During the survey, two elderly people gave up and did not complete the questionnaire. Therefore, data from the remaining 425 seniors were included in the final analysis.

Data analysis

Descriptive statistics, including count, percentage, mean, and standard deviation, were used to summarize participant characteristics and levels of health-promoting behaviors. Differences in health-promoting behaviors by sociodemographic characteristics and health care status were analyzed using t-tests. Pearson’s correlation coefficients were calculated to determine associations of health-promoting behaviors with age, perceived health competence, and social network. Stepwise multiple linear regression analysis was performed to analyze the effects of different factors on health-promoting behaviors. All statistical analyzes were performed using IBM SPSS version 25, and a P-a value below 0.05 was considered statistically significant.

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