Community health information exposure and chronic disease preventive behavior among middle-aged and older adults an exploratory sequential mixed-methods study

Introduction This study examined whether community health information exposure was associated with chronic disease preventive behavior among middle-aged and older adults, with particular attention to the chained mediating roles of risk perception and preventive self-efficacy and the moderating role of health literacy. Methods An exploratory sequential mixed-methods design was adopted. In the qualitative phase, semi-structured interviews were conducted with 27 middle-aged and older community residents from six community health service centers in Sichuan and Chongqing, China. In the quantitative phase, 704 valid questionnaires were collected through site-based convenience sampling from eight community health service centers, three senior activity stations, and family-doctor-contracted populations. Confirmatory factor analysis, structural equation modeling, and bootstrap procedures were used to test the proposed model. Results and discussion Community health information exposure was positively associated with chronic disease preventive behavior (β = 0.143, p < 0.01) and risk perception (β = 0.417, p < 0.001). Risk perception was further positively associated with preventive self-efficacy (β = 0.358, p < 0.001) and chronic disease preventive behavior (β = 0.119, p < 0.01). Preventive self-efficacy showed the strongest positive association with preventive behavior (β = 0.528, p < 0.001). Risk perception and preventive self-efficacy each showed significant indirect effects, and together formed a significant chained mediation path (indirect effect = 0.079, 95% CI [0.051, 0.115]). Health literacy significantly moderated the path from community health information exposure to risk perception (β = 0.154, p < 0.001) and was associated with a stronger chained indirect effect. Community health information exposure may contribute to chronic disease prevention partly through greater risk awareness and stronger preventive self-efficacy. Improving health literacy may help strengthen the translation of community health information into sustained preventive action, although longitudinal and intervention studies are still needed.