Regional Variations in Health Behavior Structures: A Social Determinants of Health Approach

Background/Objectives: This study analyzes how Health and Fitness Awareness influences quality of life (QOL), mediated by Health Behavior Action and Safety Behavior Practice, within the Social Determinants of Health (SDH) framework. Methods: Accordingly, a multi-group structural equation modeling (SEM) analysis was conducted on the data obtained from 6601 respondents selected from the 2024 National Sports for All Survey, jointly administered by the Ministry of Culture, Sports and Tourism and Korea Sports Promotion Foundation. Nationally representative survey data was collected across metropolitan, mid-sized, and rural areas in South Korea. The analysis further examined whether the structural pathways differed by regional size. Outcome measures included path coefficients and latent mean differences among Health and Fitness Awareness, Health Behavior Action, Safety Behavior Practice, and Improvement in QOL. Results: The analysis revealed that Health and Fitness Awareness significantly influenced both Health Behavior Action and Safety Behavior Practice; these, in turn, had positive effects on Improvement in QOL. Moreover, the structural pathways differed by region: whereas Health Behavior Action played a more significant mediating role in large cities, Safety Behavior Practice was more prominent in mid-sized ones. Conclusions: These findings are expected to provide a theoretical and policy-based foundation for region-specific health promotion strategy development and health equity advancement.