Xin Hanjia, He Chaozhu, Gu Yingying, Ma Xiuxiu, Xiang Ziying, Gong Jingjing
School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, China.
Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Front Public Health. 2025 May 23;13:1541688. doi: 10.3389/fpubh.2025.1541688. eCollection 2025.
Frailty is prevalent among preoperative gastric cancer (GC) patients and significantly affects surgical risk and long-term recovery. Family health may hold substantial potential for mitigating frailty, although the mechanisms underlying this effect remain unclear. This study aims to investigate the impact of family health on frailty in preoperative GC patients, and the mediating effects of health literacy and physical activity.
A total of 240 patients scheduled for radical gastrectomy at a tertiary hospital in China were surveyed using Family Health Scale (FHS), Health Literacy Scale (HLS-SF), International Physical Activity Questionnaire (IPAQ-7), and Tilburg Frailty Indicator (TFI). Data were analyzed using independent -tests, tests, Pearson's correlation, and binary logistic regression. Mediation analysis with Structural Equation Modeling (SEM) was then applied to explore the relationships between variables.
Family health in preoperative GC patients was negatively correlated with frailty ( = -0.791, < 0.01) and positively correlated with both health literacy ( = 0.806, < 0.01) and physical activity ( = 0.464, < 0.01). Mediating effect analysis indicated that the direct effect of family health on frailty was -0.837, while health literacy and physical activity served as partial mediators in this relationship, with indirect effects of -0.332 and -0.095 (both < 0.01), respectively. The mediating effects accounted for 33.83% of the total effect.
Family health directly affects frailty and also exerts an indirect impact through the mediators of health literacy and physical activity. These findings suggest that healthcare professionals should focus on vulnerable populations with low family health and implement family-centered preoperative frailty interventions. Guiding GC patients to improve health literacy and engage in personalized family-based exercises can help delay or reverse preoperative frailty, promoting long-term recovery outcomes.
衰弱在术前胃癌（GC）患者中普遍存在，并显著影响手术风险和长期恢复。家庭健康可能在减轻衰弱方面具有巨大潜力，尽管这种影响的潜在机制尚不清楚。本研究旨在探讨家庭健康对术前GC患者衰弱的影响，以及健康素养和身体活动的中介作用。
在中国一家三级医院对240例计划接受根治性胃切除术的患者进行了调查，使用家庭健康量表（FHS）、健康素养量表（HLS-SF）、国际体力活动问卷（IPAQ-7）和蒂尔堡衰弱指标（TFI）。数据采用独立样本t检验、方差分析、Pearson相关性分析和二元逻辑回归进行分析。然后应用结构方程模型（SEM）进行中介分析，以探讨变量之间的关系。
术前GC患者的家庭健康与衰弱呈负相关（r = -0.791，P < 0.01），与健康素养（r = 0.806，P < 0.01）和身体活动（r = 0.464，P < 0.01）均呈正相关。中介效应分析表明，家庭健康对衰弱的直接效应为-0.837，而健康素养和身体活动在此关系中起部分中介作用，间接效应分别为-0.332和-0.095（均P < 0.01）。中介效应占总效应的33.83%。
家庭健康直接影响衰弱，也通过健康素养和身体活动的中介发挥间接影响。这些发现表明，医护人员应关注家庭健康水平较低的脆弱人群，并实施以家庭为中心的术前衰弱干预措施。指导GC患者提高健康素养并参与个性化的家庭锻炼，有助于延缓或逆转术前衰弱，促进长期恢复结果。
