Abstract Body: Introduction: Identifying the predictors of healthy lifestyles among young and middle-aged adults with metabolic risk factors is of paramount importance for designing effective lifestyle interventions to manage this clinical cohort. This study aimed to examine the impact of self-efficacy, knowledge, social support, depression, and anxiety on health-promoting lifestyles among young and middle-aged adults with metabolic risk factors.
Methods: A cross-sectional study was conducted in China from October 2022 to April 2024. Data were collected from 402 participants using the Self-Rated Abilities for Health Practices Scale, Metabolic Syndrome Knowledge Scale, Social Support Rating Scale, Hospital Anxiety and Depression Scale, Health-Promoting Lifestyle Profile II, and a self-designed form. The study explored the roles of self-efficacy, knowledge, social support, depression, and anxiety in relation to health-promoting lifestyles via structural equation modeling (SEM) and fuzzy-set qualitative comparative analysis (fsQCA).
Results: SEM showed that self-efficacy and depression directly affect health-promoting lifestyles in this population. Moreover, self-efficacy mediated the effects of knowledge, social support, and depression on health-promoting lifestyles. However, no significant impact of anxiety on health-promoting lifestyles was found. The fsQCA indicated two different configurations that are sufficient for contributing to a high level of health-promoting lifestyles: one characterized by high levels of self-efficacy and knowledge alongside low levels of depression, and another with high levels of self-efficacy and social support, combined with low levels of depression and anxiety.
Conclusions: The SEM identified significant predictors of health-promoting lifestyles, which were reinforced and complemented by fsQCA results. These findings offer practical implications for healthcare professionals in developing effective interventions to promote health-promoting lifestyles among young and middle-aged adults with metabolic risk factors.