Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 21, 2025
Date Accepted: Oct 22, 2025
From Passive to Active - Improving the Healthy Self-Help Behavior of the Older Adults Through Community Health Association: A Mixed-Methods Study
ABSTRACT
Background:
While China's aging population and strained healthcare resources heighten the need for effective health promotion, traditional community health education faces barriers such as passive participation among older adults, short-term behavioural changes, and limited sustainability.
Objective:
This study aims to develop and examine the impact of an innovative community healthy self-help education model for older adults (CHSE-O) on healthy behavior and active health awareness among older people.
Methods:
A mixed-methods study was conducted enrolling a total of 80 older participants, including a 12-month pre-post controlled trial in five communities in Shanghai, China. Health behaviors, autonomy, and digital health literacy were assessed at baseline, 6 months, and 12 months using standardized scales (measuring Health-Promoting Lifestyle, Self-Rated Abilities for Health Practices, Healthy Self-Management Behaviors, Participation/Autonomy, and eHealth Literacy). Comparisons of scale scores at each time point were analysed using repeated measures ANOVA. Semi-structured interviews were conducted after the intervention (n=11), focusing on the dimensions of willingness to manage health, behavioral transformation, social role change and attend experiences, and themes were extracted through thematic analysis.
Results:
Intervention participants showed significant improvement in healthy self-help behavior (P<0.01). Sustained enhancements occurred in health promotion lifestyle, health practices ability, participation and autonomy, and e-health literacy (P<0.01). Qualitative analysis revealed enhanced active health awareness, motivation for self-management, social engagement capacity, and health information discernment.
Conclusions:
The CHSE-O significantly enhanced older adults' healthy self-management behavior, active health awareness, and eHealth literacy. By integrating professional support with peer empowerment, it addressed core limitations of traditional models: low engagement and unsustainable behavioral change. This community-embedded approach provides a scalable solution for sustainable health promotion, with significant policy implications for alleviating healthcare system pressures and advancing active aging.
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