A Path Model Analysis of the Causal Relationship between Self-care Agency and Healthy Behavior in Community-dwelling Older People from the GAINA Study

Background Self-care agency is an important determinant of self-care behavior. The purpose of this study was to identify the causal relationship between self-care agency and healthy behavior, and to construct a conceptual model of healthy behavior among older people living in a rural community. Methods This study was conducted as a cross-sectional survey at the Hino, a town in western Tottori Prefecture, Japan. Participants who were enrolled in the Good Ageing and Intervention against Nursing Care and Activity Decline (GAINA) study from 2014 to 2018 (467 new participants) were initially investigated. Of 398 participants aged >= 65 years, 5 were excluded due to missing data, and thus 393 were analyzed. Nurse researchers conducted face-to-face interviews with participants to check the accuracy of data obtained from a self-administered questionnaire, which included demographic information, physical condition (comorbidities, knee pain, low back pain, and locomotive syndrome), healthy behavior, and self-care agency. Correlations among variables were investigated by Pearson's correlation coefficient analysis, and path analysis was performed to assess causal relationships. Results A total of 393 persons (160 men and 233 women) were investigated, ranging in age from 65 to 92 years, with a mean age of 75.1 years (SD: 6.9 years). Path analysis revealed poor fit of a model in which pain and locomotive syndrome were factors inhibiting healthy behavior. When the model included only self-care agency, the indices of model fit were almost satisfactory (Goodness-of-fit index = 0.967, Adjusted goodness-of-fit index = 0.900, Comparative fit index = 0.951, and Root mean square error of approximation = 0.088), and the coefficient of determination (R-2) was 0.38. The self-care agency items with the greatest influence on healthy behavior were the ability to "grasp the techniques/tips needed to maintain health," and the ability to "persist with healthy behavior." Conclusion Self-care agency can promote healthy behavior among community-dwelling older people. Regardless of physical problems such as pain and locomotive syndrome, older people have the potential to adopt positive healthy behavior if they acquire self-care agency.