Effective pathways for driving self-management among older adults with osteoporosis: a structural equation modeling study based on individual and family self-management theories

Purpose Based on theories of individual and family self-management, this study examines the key factors associated with the activation of self-management among older adults with osteoporosis and the mechanisms underlying these effects, thereby providing a theoretical foundation for developing targeted public health intervention strategies. Methods Using a cross-sectional study design, 298 older adult patients with osteoporosis were recruited from a tertiary hospital in Chengdu, China, and the Cuqiao community between June and November 2025. Data were collected using the Patient Activation Measure, the Brief Illness Perception Questionnaire, the Positive and Negative Affect Schedule, the Patient Assessment of Chronic Illness Care, Perceived Social Support Scale, and Osteoporosis Self-Efficacy Scale. Structural equation modeling was employed to validate the predictive relationship between the model variables and patient activation. Results Social support and the quality of chronic disease care are the primary factors associated with self-management activation among older adult patients with osteoporosis, exerting both direct and indirect effects; positive emotions and perceived disease threat have no significant direct effects, but both exert indirect effects fully mediated by self-efficacy; negative emotions have both a direct negative effect on self-management engagement and an indirect negative effect by undermining self-efficacy. The model fit is good (CFI = 0.967, RMSEA = 0.025). Conclusion Social support and the quality of chronic illness care are key intervention targets that drive self-management activation among older adults with osteoporosis. Efforts should be made to strengthen the family-community-healthcare support network, improve the quality of care services, and enhance patients’ self-efficacy and the early identification of negative emotions to promote active patient participation in health management and improve health outcomes.