Social support and health behaviors of older adults during the COVID-19 pandemic in China: a moderated mediation model of loneliness and economic income.

Background: The literature shows that social support is an important factor influencing health behaviors. This study aimed to explore the relationships and intrinsic pathways of social support, loneliness, economic income, and health behaviors among older adults during the Corona Virus Disease 2019 (COVID-19) pandemic, and to provide a theoretical basis for the implementation of health behaviors interventions for older adults.

Methods: A cluster-random-sampling survey was adopted within two towns in Dongguan, China. Demographic characteristics, social support, loneliness, economic income and health behaviors were measured. The Social Support Appraisals scale (SS-A), the ULS-8 Loneliness Scale, and the Self-rated abilities for health practice scale (SRAHPS) were used to measure social support, loneliness, and health behaviors in older adults, respectively. A moderated mediation model was built to examine the relationships among social support, loneliness, economic income, and health behaviors using the SPSS PROCESS 4.0 macro. We conducted bootstrapping of regression estimates with 5000 samples and a 95% confidence interval.

Results: 621 older adults completed the questionnaire. Most of the participants were female, accounting for 75.0%, and the average age was 81.11 years (SD = 8.11). The median (interquartile range) of the participants' average monthly economic income was 800 (500-1000)RMB. The results of the mediation analysis showed that loneliness partly mediated the relationship between social support and health behaviors (B = 0.024, 95%CI: 0.007, 0.042), with the mediating effect accounting for 4.56% of the total effect. The moderation mediation analysis revealed a positive moderating role of economic income in the relationship between social support and loneliness (B = 0.114, 95%CI: 0.054, 0.174). Specifically, the relationship between social support and loneliness was found to be weaker for older adults with a high economic income compared to those with a lower economic income.

Conclusion: The provision of enhanced social support and the alleviation of loneliness among older adults during an epidemic can facilitate the development of healthy behaviours, particularly among those who are economically disadvantaged.