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Article(id=1324044625895367654, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044540067328424, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202506254, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1750003200000, receivedDateStr=2025-06-16, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793606438373, onlineDateStr=2026-11-02, pubDate=1777046400000, pubDateStr=2026-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793606438373, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793606438373, creator=13701087609, updateTime=1793606438373, updator=13701087609, issue=Issue{id=1324044540067328424, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='8', pageStart='1345', pageEnd='1536', issueExtLink='null', onlineDate='null', pubDate='1777046400000', pubDateStr='2026-04-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793606417910, creator='13701087609', updateTime=1793670137580, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311799788602160, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044540067328424, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311799788602161, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044540067328424, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1453, endPage=1458, ext={EN=ArticleExt(id=1324044626134442983, articleId=1324044625895367654, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The chain-mediating effect of health literacy and self-efficacy between social support and health-promoting behaviors in older adults, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the chain-mediating role of health literacy and self-efficacy in the relationship between social support and health-promoting behaviors among older adults.

Methods

From September to December 2024, a multi-stage random sampling method was adopted to conduct a questionnaire survey among 1 152 elderly individuals aged 60 and above in Shandong Province. Pearson correlation analysis was used to analyze the correlations among social support, health literacy, self-efficacy, and health-promoting behaviors. Using SPSS software and its PROCESS plug-in, a chain mediation model was constructed to analyze the mediating effects of health literacy and self-efficacy in this relationship, with significance tested via the Bootstrap method.

Results

The direct effect of social support on health-promoting behaviors was significant (β=0.586, 95%CI: 0.503-0.669). The mediating effect of health literacy between social support and health-promoting behaviors was significant, with an effect value of 0.138 (95%CI: 0.100-0.179). The mediating effect of self-efficacy between social support and health-promoting behaviors was significant, with an effect value of 0.125 (95%CI: 0.087-0.167). The chain-mediating effect of health literacy and self-efficacy between social support and health-promoting behaviors was significant, with an effect value of 0.076 (95% CI: 0.053-0.104).

Conclusion

Social support has a positive predictive effect on the health-promoting behaviors of older adults. Social support indirectly influences the health-promoting behaviors of older adults through health literacy and self-efficacy.

, authors=Yin-xin HOU, Hui FANG, Ying-xin DUAN, Shan-ju HU, authorsList=Yin-xin HOU, Hui FANG, Ying-xin DUAN, Shan-ju HU, authorCompany=null, correspAuthors=Shan-ju HU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324044628172874736, articleId=1324044625895367654, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=健康素养与自我效能感在社会支持与老年人健康促进行为间的链式中介效应, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

了解健康素养和自我效能感在社会支持与老年人健康促进行为之间的链式中介作用。

方法

于2024年9-12月，采用多阶段随机抽样方法，对山东省1 152名60岁及以上老人开展问卷调查。使用Pearson相关分析法分析社会支持、健康素养、自我效能感与健康促进行为之间的相关关系，运用SPSS软件及其PROCESS插件，构建链式中介效应模型，分析健康素养与自我效能感在其中的中介效应，采用Bootstrap检验显著性。

结果

社会支持对健康促进行为直接效应显著（β=0.586，95%CI：0.503~0.669），健康素养在社会支持与健康促进行为间中介效应显著，效应值为0.138（95%CI：0.100~0.179）；自我效能感在社会支持与健康促进行为间中介效应显著，效应值为0.125（95%CI：0.087~0.167），健康素养和自我效能感在社会支持与健康促进行为间链式中介显著，效应值为0.076（95%CI：0.053~0.104）。

结论

社会支持对老年人健康促进行为具有正向预测作用。社会支持通过健康素养和自我效能感间接地对老年人健康促进行为产生影响。

, authors=侯银鑫, 房慧, 段颖欣, 胡善菊, authorsList=侯银鑫, 房慧, 段颖欣, 胡善菊, authorCompany=null, correspAuthors=胡善菊, authorNote=

侯银鑫（2000—），男，硕士在读，研究方向：社会保障、老年健康

, correspAuthorsNote=
胡善菊，E-mail：
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(In Chinese), articleTitle=Relationship between Mental Health Literacy and Health Behaviors among Elderly Stroke Patients, refAbstract=null), Reference(id=1324044643503054916, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, doi=null, pmid=null, pmcid=null, year=2023, volume=40, issue=7, pageStart=34, pageEnd=38, url=null, language=null, rfNumber=[24], rfOrder=38, authorNames=李松, 和欢, 李红玉, journalName=军事护理, refType=null, unstructuredReference=李松, 和欢, 李红玉, 等. 康复锻炼行为执行意向和心理健康素养在住院脑卒中患者领悟社会支持和健康行为之间的链式中介作用[J]. 军事护理, 2023, 40(7): 34-38., articleTitle=康复锻炼行为执行意向和心理健康素养在住院脑卒中患者领悟社会支持和健康行为之间的链式中介作用, refAbstract=null), Reference(id=1324044643574358085, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, doi=null, pmid=null, pmcid=null, year=2023, volume=40, issue=7, pageStart=34, pageEnd=38, url=null, language=null, rfNumber=[24], rfOrder=39, authorNames=Li S, He H, Li HY, journalName=Military Nursing, refType=null, unstructuredReference=Li S, He H, Li HY, et al. Chain mediating effects of executive intention of rehabilitation exercise behaviors and mental health literacy between perceived social support and health behaviors among stroke inpatients[J]. Military Nursing, 2023, 40(7): 34-38. (In Chinese), articleTitle=Chain mediating effects of executive intention of rehabilitation exercise behaviors and mental health literacy between perceived social support and health behaviors among stroke inpatients, refAbstract=null)], funds=[Fund(id=1324044635919753244, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, awardId=ZR2020MG062, language=CN, fundingSource=山东省自然科学基金(ZR2020MG062), fundOrder=null, country=null), Fund(id=1324044636037193757, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, awardId=24CXSXJ14, language=CN, fundingSource=山东省习近平新时代中国特色社会主义思想研究中心、山东省社会科学规划研究专项(24CXSXJ14), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324044630362301425, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, xref=null, ext=[AuthorCompanyExt(id=1324044630366495730, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, companyId=1324044630362301425, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Management, Shandong Second Medical University, Weifang, Shangdong 261053, China), AuthorCompanyExt(id=1324044630374884339, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, companyId=1324044630362301425, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=山东第二医科大学管理学院，山东　潍坊　261053)])], figs=[ArticleFig(id=1324044634896343058, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, language=EN, label=Fig. 1, caption=Chain mediation effect model diagram, figureFileSmall=cdwQP4LCltsKk1GgvFJCYg==, figureFileBig=FnkXD6IxktOH5hJ58K4ESw==, tableContent=null), ArticleFig(id=1324044634963451923, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, language=CN, label=图1, caption=链式中介效应模型图, figureFileSmall=cdwQP4LCltsKk1GgvFJCYg==, figureFileBig=FnkXD6IxktOH5hJ58K4ESw==, tableContent=null), ArticleFig(id=1324044635135418388, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, language=EN, label=Table 1, caption=

Comparison of health-promoting behavior scores among older adults with different characteristics

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变量n（%）健康促进行为得分（）F/tP
年龄（岁）18.095<0.001
60~69547（47.5）102.23+16.62
70~79443（38.5）97.31+15.77
≥80162（14.1）95.19+13.73
性别0.3140.575
男性536（46.5）99.63±15.15
女性616（53.5）99.10±16.98
文化程度38.971<0.001
未上过学312（27.1）92.93±13.82
小学406（35.2）97.75±13.74
初中264（22.9）101.24±16.99
高中117（10.2）110.46±15.20
大学专科32（2.8）118.31±19.75
大学本科及以上21（2.1）110.95±17.27
婚姻状况5.1940.001
已婚946（82.1）100.08±15.97
丧偶196（17.0）96.15±16.61
离异6（0.5）101.00±5.44
未婚4（0.3）80.00±20.79
户籍类型58.480<0.001
城市234（20.3）106.38±16.25
农村918（79.7）97.55±15.64
独居8.4050.004
是172（14.9）96.06±14.03
否980（85.1）99.92±16.43
慢性病数量（种）18.310<0.001
0413（35.9）103.65±17.16
1362（31.4）97.93±15.64
2264（22.9）97.10±14.52
≥3113（9.8）93.40±13.84
), ArticleFig(id=1324044635231887381, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, language=CN, label=表1, caption=

不同特征老年人健康促进行为得分差异

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变量n（%）健康促进行为得分（）F/tP
年龄（岁）18.095<0.001
60~69547（47.5）102.23+16.62
70~79443（38.5）97.31+15.77
≥80162（14.1）95.19+13.73
性别0.3140.575
男性536（46.5）99.63±15.15
女性616（53.5）99.10±16.98
文化程度38.971<0.001
未上过学312（27.1）92.93±13.82
小学406（35.2）97.75±13.74
初中264（22.9）101.24±16.99
高中117（10.2）110.46±15.20
大学专科32（2.8）118.31±19.75
大学本科及以上21（2.1）110.95±17.27
婚姻状况5.1940.001
已婚946（82.1）100.08±15.97
丧偶196（17.0）96.15±16.61
离异6（0.5）101.00±5.44
未婚4（0.3）80.00±20.79
户籍类型58.480<0.001
城市234（20.3）106.38±16.25
农村918（79.7）97.55±15.64
独居8.4050.004
是172（14.9）96.06±14.03
否980（85.1）99.92±16.43
慢性病数量（种）18.310<0.001
0413（35.9）103.65±17.16
1362（31.4）97.93±15.64
2264（22.9）97.10±14.52
≥3113（9.8）93.40±13.84
), ArticleFig(id=1324044635328356374, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, language=EN, label=Table 2, caption=

Descriptive statistics and correlation analysis of the variables (r)

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变量得分（）社会支持健康素养自我效能感健康促进行为
社会支持46.63±8.641.000
健康素养83.78±17.030.329a1.000
自我效能感24.05±6.350.414a0.657a1.000
健康促进行为99.35±16.150.521a0.617a0.628a1.000
), ArticleFig(id=1324044635408048151, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, language=CN, label=表2, caption=

各变量的描述统计及相关分析（r）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量得分（）社会支持健康素养自我效能感健康促进行为
社会支持46.63±8.641.000
健康素养83.78±17.030.329a1.000
自我效能感24.05±6.350.414a0.657a1.000
健康促进行为99.35±16.150.521a0.617a0.628a1.000
), ArticleFig(id=1324044635538071576, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, language=EN, label=Table 3, caption=

Multiple mediation model regression analysis results

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变量模型1健康素养模型2自我效能感模型3健康促进行为
βtβtβt
社会支持0.46210.329b0.1589.305b0.58613.857b
健康素养0.20819.387b0.29910.068b
自我效能感0.79211.163b
教育水平7.60620.670b0.2141.365-0.256-0.681
文化程度1.3001.2241.0382.690b-0.946-1.020
独居2.4681.979a0.1790.3954.3654.012b
慢性病数量-2.196-5.662b-0.651-4.556b0.2290.662
婚姻状况-5.995-5.878b-1.243-3.305b0.9030.998
年龄-0.200-3.754b0.0683.509b-0.202-4.288b
常量67.73515.261b-5.166-2.922b42.3209.946b
R=0.685R=0.705R=0.744
R2=0.469R2=0.497R2=0.553
F=144.253bF=141.142bF=157.038b
), ArticleFig(id=1324044635634540569, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, language=CN, label=表3, caption=

多重中介模型回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1健康素养模型2自我效能感模型3健康促进行为
βtβtβt
社会支持0.46210.329b0.1589.305b0.58613.857b
健康素养0.20819.387b0.29910.068b
自我效能感0.79211.163b
教育水平7.60620.670b0.2141.365-0.256-0.681
文化程度1.3001.2241.0382.690b-0.946-1.020
独居2.4681.979a0.1790.3954.3654.012b
慢性病数量-2.196-5.662b-0.651-4.556b0.2290.662
婚姻状况-5.995-5.878b-1.243-3.305b0.9030.998
年龄-0.200-3.754b0.0683.509b-0.202-4.288b
常量67.73515.261b-5.166-2.922b42.3209.946b
R=0.685R=0.705R=0.744
R2=0.469R2=0.497R2=0.553
F=144.253bF=141.142bF=157.038b
), ArticleFig(id=1324044635718426650, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, language=EN, label=Table 4, caption=

Significance test of mediating effects

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路径效应值（95%CI）SE效应占比（%）
总效应0.925（0.835~1.015）0.046100.00
直接效应0.586（0.503~0.669）0.04263.31
总间接效应0.339（0.269~0.412）0.03736.69
路径10.138（0.100~0.179）0.02014.93
路径20.125（0.087~0.167）0.02013.54
路径30.076（0.053~0.104）0.0138.24
), ArticleFig(id=1324044635798118427, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044625895367654, language=CN, label=表4, caption=

中介效应显著性检验

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路径效应值（95%CI）SE效应占比（%）
总效应0.925（0.835~1.015）0.046100.00
直接效应0.586（0.503~0.669）0.04263.31
总间接效应0.339（0.269~0.412）0.03736.69
路径10.138（0.100~0.179）0.02014.93
路径20.125（0.087~0.167）0.02013.54
路径30.076（0.053~0.104）0.0138.24
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健康素养与自我效能感在社会支持与老年人健康促进行为间的链式中介效应
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侯银鑫 , 房慧 , 段颖欣 , 胡善菊
现代预防医学 | 健康与社会行为 2026,53(8): 1453-1458
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现代预防医学 |健康与社会行为 2026 , 53 (8) : 1453 -1458
健康素养与自我效能感在社会支持与老年人健康促进行为间的链式中介效应
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侯银鑫, 房慧, 段颖欣, 胡善菊
作者信息
  • 山东第二医科大学管理学院，山东　潍坊　261053
通讯作者:
胡善菊，E-mail：
作者简介:

侯银鑫（2000—），男，硕士在读，研究方向：社会保障、老年健康

The chain-mediating effect of health literacy and self-efficacy between social support and health-promoting behaviors in older adults
Yin-xin HOU, Hui FANG, Ying-xin DUAN, Shan-ju HU
Affiliations
  • School of Management, Shandong Second Medical University, Weifang, Shangdong 261053, China
出版时间: 2026-04-25 doi: 10.20043/j.cnki.MPM.202506254
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摘要
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目的

了解健康素养和自我效能感在社会支持与老年人健康促进行为之间的链式中介作用。

方法

于2024年9-12月，采用多阶段随机抽样方法，对山东省1 152名60岁及以上老人开展问卷调查。使用Pearson相关分析法分析社会支持、健康素养、自我效能感与健康促进行为之间的相关关系，运用SPSS软件及其PROCESS插件，构建链式中介效应模型，分析健康素养与自我效能感在其中的中介效应，采用Bootstrap检验显著性。

结果

社会支持对健康促进行为直接效应显著（β=0.586，95%CI：0.503~0.669），健康素养在社会支持与健康促进行为间中介效应显著，效应值为0.138（95%CI：0.100~0.179）；自我效能感在社会支持与健康促进行为间中介效应显著，效应值为0.125（95%CI：0.087~0.167），健康素养和自我效能感在社会支持与健康促进行为间链式中介显著，效应值为0.076（95%CI：0.053~0.104）。

结论

社会支持对老年人健康促进行为具有正向预测作用。社会支持通过健康素养和自我效能感间接地对老年人健康促进行为产生影响。

社会支持  /  健康促进行为  /  健康素养  /  自我效能感  /  链式中介
Objective

To understand the chain-mediating role of health literacy and self-efficacy in the relationship between social support and health-promoting behaviors among older adults.

Methods

From September to December 2024, a multi-stage random sampling method was adopted to conduct a questionnaire survey among 1 152 elderly individuals aged 60 and above in Shandong Province. Pearson correlation analysis was used to analyze the correlations among social support, health literacy, self-efficacy, and health-promoting behaviors. Using SPSS software and its PROCESS plug-in, a chain mediation model was constructed to analyze the mediating effects of health literacy and self-efficacy in this relationship, with significance tested via the Bootstrap method.

Results

The direct effect of social support on health-promoting behaviors was significant (β=0.586, 95%CI: 0.503-0.669). The mediating effect of health literacy between social support and health-promoting behaviors was significant, with an effect value of 0.138 (95%CI: 0.100-0.179). The mediating effect of self-efficacy between social support and health-promoting behaviors was significant, with an effect value of 0.125 (95%CI: 0.087-0.167). The chain-mediating effect of health literacy and self-efficacy between social support and health-promoting behaviors was significant, with an effect value of 0.076 (95% CI: 0.053-0.104).

Conclusion

Social support has a positive predictive effect on the health-promoting behaviors of older adults. Social support indirectly influences the health-promoting behaviors of older adults through health literacy and self-efficacy.

Social support  /  Health-promoting behaviors  /  Health literacy  /  Self-efficacy  /  Chain-mediating effect
侯银鑫, 房慧, 段颖欣, 胡善菊. 健康素养与自我效能感在社会支持与老年人健康促进行为间的链式中介效应. 现代预防医学, 2026 , 53 (8) : 1453 -1458 . DOI: 10.20043/j.cnki.MPM.202506254
Yin-xin HOU, Hui FANG, Ying-xin DUAN, Shan-ju HU. The chain-mediating effect of health literacy and self-efficacy between social support and health-promoting behaviors in older adults[J]. Modern Preventive Medicine, 2026 , 53 (8) : 1453 -1458 . DOI: 10.20043/j.cnki.MPM.202506254
正文
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我国作为世界上老年人口规模最大，老龄化速度较快的国家之一，老年群体的“长寿不健康”现象日益突出，已成为亟待解决的社会难题。WTO指出，人类60%的健康问题与个人行为和生活方式密切相关[1]。因此解决该难题必须聚焦老年人的健康促进行为。健康促进是以自我实现为导向，促使个体保持或改善健康所采取的所有行为和生活方式的统称，能够有效降低健康风险并预防疾病发生[2]。社会支持能够直观反映个体与社会之间联系的紧密程度及质量水平，对老年人健康促进行为有重要影响[3]。并且社会支持的提供，可以强化老年人健康素养，提高老年人的自我效能感，促使老年人保持相对较高的认知水平[4-7]。以往研究发现，健康素养和自我效能感对健康促进行为有一定的影响[8-9]。
然而，目前少有对社会支持、健康素养、自我效能感和健康促进行为之间关系的研究。社会认知理论强调环境因素、个体因素与行为之间的三元交互作用，认为环境因素（如社会支持）既能直接促使行为发生改变，也能通过个体因素（如健康素养、自我效能感等）间接实现行为的转变[10]。因此，本研究基于社会认知理论，探讨健康素养和自我效能感在社会支持与老年人健康促进行为之间的链式中介作用，为提升老年人健康水平，研制老年人健康促进行为干预策略提供实证支持。
1　对象与方法
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1.1　研究对象
本研究采用多阶段分层随机抽样方法，于2024年9-12月依据经济发展水平，从山东省内选取了3个地级市，并在每个地级市中选取1个县/区，在每个县/区中抽取了3个具有代表性的社区，每个社区针对符合纳排标准的老年人开展问卷调查。纳入标准：（1）年龄≥60周岁；（2）自愿参加本研究并签署知情同意书；（3）意识清楚，有正常的沟通交流能力、视听觉能力，能够理解并配合。排除标准：（1）伴有认知、精神障碍及视力、听力功能严重缺损者；（2）不能够理解问卷内容。共发放问卷1 166份，剔除无效问卷14份后，最终回收有效问卷1 152份，有效回收率达到98.8%。年龄平均70.68±7.75岁。本研究已通过山东第二医科大学医学伦理委员会审查（编号：2025YX026），并已获得所有调查者的知情同意。
1.2　调查工具
1.2.1　一般资料问卷
包括年龄、性别、文化程度、婚姻状况、户籍类型、独居、慢性病数量等。
1.2.2　社会支持量表
借鉴肖水源，姜乾金[11-12]等人设计的量表自行研制，包括正式支持与非正式支持两个维度。正式社会支持是指个体从政府、社区或专业机构获得的帮助，如老年人福利保障、医疗援助等；非正式社会支持是指个体从家庭成员、友邻等获得的帮助，如感情陪伴、日常照料等。共有14个条目，采用李克特五级计分方法，量表总分70分。得分越高，获得的社会支持越多。量表研制过程进行了严格的信效度分析：信度方面，正式社会支持维度的Cronbacha α系数为0.867，非正式社会支持维度为0.843，总体Cronbacha α系数为0.855，说明问卷各条目内部一致性极佳；效度方面，KMO取样适切性量数为0.868，Bartlett球形检验P<0.001，数据高度适合因子分析。采用主成分分析提取出2个特征值>1的公因子，累积方差贡献率61.581%，超过60%，且所有条目的因子载荷均>0.5，无双重高载荷现象，表明量表具有可靠的科学性。
1.2.3　健康素养量表（Health Literacy Management Scale，HLMS）
采用孙浩林编制的慢性病健康素养量表[13]。包括信息获取能力、交流互动能力、改善健康意愿和经济支持意愿4个维度，共24个条目。采用李克特五级计分方法，量表总分120分，分数越高表明健康素养越好。本研究中该量表Cronbacha α系数为0.945。
1.2.4　一般自我效能感量表（General Self-Efficacy Scale，GSES）
采用由Schwarzer等人编制，王才康等人翻译修订的一般自我效能感量表[14]。共10道题目，采用李克特4点计分，量表总分40分，得分越高表示自我效能感越强。本研究中该量表Cronbacha α系数为0.936。
1.2.5　健康促进生活方式量表（Health-Promoting Lifestyle Profile Ⅱ，revise，HPLP-ⅡR）
国内一般采用健康促进生活方式量表测量个体健康促进行为。本研究采用曹文君[15]等人修订的HPLP-ⅡR中文版，包括人际关系、健康责任、压力管理、营养、体育运动、精神成长6个维度，共计40个条目。采用李克特四级量表计分方法，量表总分160分，总分越高，表明个体健康促进行为越好。本研究中该量表的Cronbacha α系数为0.929。
1.3　统计学方法
使用Excel 2021进行问卷数据的录入与整理，借助SPSS 25.0软件进行数据分析。计量资料用（）表示，计数资料用[n（%）]表示；采用t检验和方差分析，分析不同人口学特征的老年人健康促进行为得分的差异性；用Harman单因素检验数据的共同方法偏差；采用Pearson相关分析法明确社会支持、健康素养、自我效能感与健康促进行为之间的相关关系；使用PROCESS中model6插件进行中介效应检验。检验水准α=0.05。
2　结果
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2.1　共同方法偏差
Harman单因素检验共同方法偏差结果显示，特征值大于1的因子有14个，第一个因子的方差解释度为26.408%（<40%），因此判定不存在显著的共同方法偏差。
2.2　老年人基本情况
本研究纳入分析的1 152名老年人中，男性536人，女性616人。结果显示，年龄、教育水平、婚姻状况、户籍类型、独居以及慢性病数量等因素在健康促进行为得分的差异具有统计学意义。见表1。
2.3　社会支持、健康素养、自我效能感和健康促进行为的描述统计及相关分析
老年人社会支持平均得分为46.63±8.64；健康促进行为平均得分为99.35±16.15；自我效能感平均得分为24.05±6.35；健康素养平均得分为83.78±17.03。社会支持与健康促进行为（r=0.521，P<0.01）、自我效能感（r=0.414，P<0.01）、健康素养（r=0.329，P<0.01）均呈现出正相关；健康素养与自我效能感（r=0.657，P<0.01）、健康促进行为（r=0.617，P<0.01）均呈现出正相关；自我效能感与健康促进行为（r=0.628，P<0.01）呈现正相关。见表2。
2.4　健康素养和自我效能感在社会支持与老年人健康促进行为间多重中介模型分析
将社会支持作为自变量，健康促进行为作为因变量，健康素养和自我效能感作为中介变量，引入控制变量构建多重中介模型。结果显示，社会支持对健康素养（β=0.462，P<0.001）、自我效能感（β=0.158，P<0.001）以及健康促进行为（β=0.586，P<0.001）具有正向预测作用；健康素养对自我效能感（β=0.208，P<0.001）和健康促进行为（β=0.299，P<0.001）具有正向预测作用；自我效能感对健康促进行为（β=0.792，P<0.001）具有正向预测作用。表明健康素养和自我效能感在社会支持与老年人健康促进行为之间存在链式中介。见表3。
2.5　健康素养和自我效能感在社会支持与老年人健康促进行为间中介作用检验
根据链式中介路径分析结果显示，总间接效应值为0.339，占总效应的36.69%。其中路径1：社会支持→健康素养→健康促进行为的效应值为0.138（95%CI：0.100~0.179）；路径2：社会支持→自我效能感→健康促进行为的效应值为0.125（95%CI：0.087~0.168）；路径3：社会支持→健康素养→自我效能感→健康促进行为的效应值为0.076（95%CI：0.053~0.104）；间接路径置信区间均不包含0，说明三条间接路径均显著，链式中介效应存在。见表4、图1。
3　讨论
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3.1　社会支持对老年人健康促进行为具有显著正向预测作用
研究结果显示，社会支持对健康促进行为有正向预测作用（β=0.586，P<0.001）。这与王润花等人的研究结论一致[16]。高社会支持可能直接降低了老年人采取健康行为的门槛，并通过持续的鼓励、榜样作用和情感强化，帮助启动并维持这些行为。相关研究表明，与子女的联系越密切，老年人的医疗服务使用频率越高，越有利于形成健康促进行为[17]。社区网格化管理整合了医疗服务、体检、心理咨询等社区卫生资源，为老年人的健康福祉提供坚实保障[18]。友邻提供的日常帮助与联系，可以减轻老年人对未来的担忧，增强凝聚力和归属感，有利于老年人主动利用现有社区资源，实现积极老龄化，保持健康[19]。
3.2　健康素养的中介作用分析
研究结果表明，社会支持可以通过影响健康素养间接影响老年人的健康促进行为。这其中的作用路径在于，社会支持能够增强老年人的健康素养，即提升其健康知识水平与自我决策能力。而高水平健康素养的老年人，更能够将这种内在能力转化为外在行动，表现为主动选择健康生活方式、积极参与自我保健等具体的健康促进行为。参与健康讲座、健康测评以及上门中医特色服务等社区活动的老年人，拥有更高水平的归属感和安全感，有助于老年人增强健康责任意识，采取更积极的健康促进行为[20]。与子女同住的老年人能获得更高水平的照料支持，这有利于形成健康生活理念，及时满足健康需求，并且增强健康信息的辨别能力，培养健康促进行为[21]。
3.3　自我效能感的中介作用分析
研究结果表明，社会支持可通过提升老年人的自我效能感，间接促进其健康促进行为。具体而言，正式社会支持通过提供专业的健康资源、指导与制度性保障，帮助老年人有效管理健康，从而提升自我效能感；而非正式社会支持则主要通过提供可观察的健康行为榜样和给予鼓励来发挥作用——例如，与同龄人进行积极健康比较正是一种重要的观察学习过程，已被证实能有效提升老年人的自我效能感[22]。这种经由不同路径得以提升的自我效能感，能直接驱动老年人更主动、更持久地采纳与调整健康促进行为。
3.4　健康素养与自我效能感的链式中介作用分析
研究结果表明，社会支持可以通过健康素养与自我效能感影响老年人健康促进行为。社会支持可以帮助老年患者减少对家庭的依赖，提高健康素养，找到自我价值，增强自我效能感，表现出更优越的健康促进行为[23]。同时，健康素养通过自我效能感对个体健康促进行为有健康正向效应，老年人通过增加健康知识，提高利用健康服务的能力，采取更为健康的生活行为[9]。亲戚朋友所提供的非正式社会支持，可提高老年人健康素养，降低老年人由病情引起的消极心理，提升其自我效能感，进而形成健康促进行为[24]。
综上，社会支持可以通过提高健康素养以及自我效能感，改善老年人的健康促进行为。建议政府完善医疗保障体系以降低经济负担，并整合社区医养资源，通过系统化课程与专业队伍建设，全面提升老年人的健康素养。同时，家庭及同伴通过日常情感支持、共同行为实践与积极反馈，有效增强其自我效能感，并可借助数字化工具实现个性化监督与提醒。最终通过制度保障与情感激励的双重赋能，共同促进老年人健康行为的养成与坚持。
本研究存在一定的潜在局限：其一，当前研究采用横断面数据，难以确证社会支持、健康素养、自我效能感与健康促进行为之间的时序性因果关系；其二，依赖受访者自陈问卷可能引入社会期望偏倚或回忆偏差，影响部分变量的客观性。
基金
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  • 山东省自然科学基金(ZR2020MG062)
  • 山东省习近平新时代中国特色社会主义思想研究中心、山东省社会科学规划研究专项(24CXSXJ14)
文献
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2026年第53卷第8期
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doi: 10.20043/j.cnki.MPM.202506254
  • 接收时间：2025-06-16
  • 首发时间：2026-11-02
  • 出版时间：2026-04-25
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  • 收稿日期：2025-06-16
基金
山东省自然科学基金(ZR2020MG062)
山东省习近平新时代中国特色社会主义思想研究中心、山东省社会科学规划研究专项(24CXSXJ14)
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    山东第二医科大学管理学院，山东　潍坊　261053

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