Predictors of health management participation in community-dwelling older adults: a cross-sectional study based on the health belief model

Objective This study aimed to assess the current status of health management cognition, health beliefs, and behaviors among community-dwelling older adults in Nanning, China, and to identify factors influencing their health management behaviors using the Health Belief Model (HBM). Methods A descriptive cross-sectional study was conducted from March to June 2024. A convenience sample of 250 older adults (≥60 years) was recruited from an urban community in Nanning. Data were collected through face-to-face interviews using a structured questionnaire, including sociodemographic characteristics, health management cognition and behavior items, and a culturally adapted Health Belief Scale (10 items, five dimensions). Reliability (Cronbach's α = 0.81) and construct validity ( CFI = 0.94, RMSEA = 0.05) of the scale were confirmed. Statistical analyses included descriptive statistics, t -tests, ANOVA, Spearman's correlation, and binary logistic regression (SPSS 26.0). Results The overall mean health belief score was 3.42 ± 0.68. Perceived benefits (3.85 ± 0.72) and self-efficacy (3.12 ± 0.81) were the highest and lowest-scoring dimensions, respectively. Only 54.4% of participants had ever received health management services. Binary logistic regression revealed that higher educational level (OR = 1.38, 95% CI : 1.01–1.90), higher monthly income (OR = 1.32, 95% CI : 1.01–1.72), presence of chronic disease (OR = 1.52, 95% CI: 1.03–2.23), stronger perceived benefits (OR = 1.62, 95% CI: 1.09–2.40), and greater self-efficacy (OR = 1.68, 95% CI: 1.10–2.56) were independently associated with higher likelihood of engaging in health management. Perceived susceptibility, severity, and barriers were not significant predictors in the multivariate model. Conclusion Health management behaviors among older adults in Nanning are jointly determined by modifiable health beliefs (perceived benefits, self-efficacy) and socioeconomic resources (education, income). Public health interventions should integrate benefit-focused education, self-efficacy enhancement programs, and structural strategies to reduce access barriers for disadvantaged subgroups, particularly those with lower education and income levels.