School of Public Health, Fudan University, Xuhui District, Shanghai, China.
School of Humanities, Shanghai Institute of Technology, Fengxian District, Shanghai, China.
J Glob Health. 2024 Mar 22;14:04059. doi: 10.7189/jogh.14.04059.
The heavy burden of non-communicable chronic diseases (NCDs) and the deficiency of health behaviours (HB) are threatening the middle- and older-aged population in China. However, little is known about the relational mechanism between health shocks (HS) and HBs, while the importance of patients' perception of lifestyle advice (PPLA) to initiate HB is insufficiently emphasised. In this study, we aimed to examine this perception as a mediator between HS and HB and the variety of mediation effects caused by the different contents of lifestyle advice.
We retrieved panel data from the two latest waves of a nationally representative cohort, the China Health and Retirement Longitudinal Study (CHARLS). After constructing well-balanced groups through propensity score matching, we conducted descriptive and multilevel logistic regression analyses to analyse the state of and factors influencing PPLA. We employed the Preacher's Sobel test with 1000 replications bootstrap to examine the mediating effect of PPLA.
On a sample of 7922 respondents (post-propensity score matching), we found that HSs had a positive direct effect on HB, with observed decreases in smoking and drinking and increases in exercise. A limited and selected perception of lifestyle advice showed a gap between the advice given by providers and perceived by patients, with gender, education level, social support inside the family, self-reported health, comorbidity, treatment regimens, and utilisation of family doctors being significant influencing factors. Nevertheless, any content of lifestyle advice partially mediated the relationship in which HS increases non-addictive HB (exercise), while only the targeted and detailed content of lifestyle advice about corresponding behaviours partially mediated the effect between HS and addictive HB (smoking and drinking).
This study provides the first evidence that PPLA partially mediates the positive effect of HS on HB. Personalised chronic disease management; targeted advice and interventions; and multiple social resources COULD BE beneficial for patients with HS to initiate HB.
非传染性慢性病（NCDs）负担沉重，健康行为（HB）不足，这对中国的中老年人群构成威胁。然而，人们对健康冲击（HS）与 HB 之间的关系机制知之甚少，而患者对生活方式建议的感知（PPLA）对启动 HB 的重要性也没有得到足够的重视。在这项研究中，我们旨在检验这种感知作为 HS 与 HB 之间的中介，并检验不同生活方式建议内容引起的多种中介效应。
我们从具有全国代表性的队列研究——中国健康与退休纵向研究（CHARLS）的最新两轮中检索了面板数据。通过倾向评分匹配构建了均衡组后，我们进行了描述性和多层次逻辑回归分析，以分析 PPLA 的状态和影响因素。我们采用了 Preacher 的 Sobel 检验，使用 1000 次复制自举法检验 PPLA 的中介效应。
在 7922 名受访者（倾向评分匹配后）的样本中，我们发现 HS 对 HB 有正向直接影响，表现为吸烟和饮酒减少，运动增加。有限且选择性的生活方式建议显示出提供者提供的建议与患者感知之间的差距，性别、教育水平、家庭内部的社会支持、自我报告的健康状况、合并症、治疗方案以及家庭医生的利用情况是显著的影响因素。然而，任何内容的生活方式建议都部分中介了 HS 增加非成瘾性 HB（运动）的关系，而只有针对相应行为的有针对性和详细的生活方式建议内容部分中介了 HS 与成瘾性 HB（吸烟和饮酒）之间的关系。
本研究首次提供了证据表明 PPLA 部分中介了 HS 对 HB 的正向影响。个性化的慢性病管理；有针对性的建议和干预措施；以及多种社会资源可能对有 HS 的患者启动 HB 有益。
