# Factors influencing health-promoting lifestyles in young and middle-aged adults with metabolic risk factors: a network analysis

## TL;DR

This study identifies key factors like self-efficacy and knowledge that influence healthy lifestyles in adults with metabolic risks, suggesting these should be targeted in interventions.

## Contribution

The study introduces a network analysis approach to identify self-efficacy for psychological well-being as a central factor in promoting healthy lifestyles.

## Key findings

- Self-efficacy and knowledge are strong predictors of dietary behaviors in adults with metabolic risk factors.
- Self-efficacy for psychological well-being is a central factor influencing health-promoting lifestyles.
- Depression and social support significantly impact stress management behaviors.

## Abstract

Metabolic dysfunction is prevalent among young and middle-aged adults and impairs their health. Adopting healthy lifestyles is essential for preventing and managing these issues. By determining modifiable factors that influence health-promoting lifestyles, we can gain valuable insights for developing targeted lifestyle interventions. Therefore, this study aims to identify factors contributing to health-promoting lifestyles among young and middle-aged adults with metabolic risk factors.

A cross-sectional study design was adopted. Data were obtained from 402 young and middle-aged adults with metabolic risk factors, recruited via convenience sampling from community health centers in China between October 2022 and April 2024. All participants were measured for knowledge (MetS Knowledge Scale), self-efficacy (Self-Rated Abilities for Health Practices Scale), social support (Social Support Rating Scale), depression (Hospital Anxiety and Depression Scale-Depression), anxiety (Hospital Anxiety and Depression Scale-Anxiety), and health-promoting lifestyles (Health-Promoting Lifestyle Profile II). The impact of self-efficacy, knowledge, social support, depression, anxiety on health-promoting lifestyles was estimated using regression and network analysis via SPSS and R program, respectively.

The mean scores for knowledge, social support, depression, anxiety, self-efficacy, and health-promoting lifestyles are 28.01 (SD = 12.31), 39.81 (SD = 7.52), 4.60 (SD = 3.25), 5.22 (SD = 3.50), 65.92 (SD = 22.43), and 58.25 (SD = 7.52), respectively. After controlling the covariates, the regression analysis showed that knowledge (β = 0.176, P < 0.001) and self-efficacy (β = 0.299, P < 0.001) are crucial predictors of dietary behaviors. Social support (β = 0.099, P = 0.027), depression (β=-0.181, P < 0.001), and self-efficacy (β = 0.434, P < 0.001) had significant effects on stress management. In addition, self-efficacy (β = 0.485, P < 0.001) plays an important role in physical activity. The network analysis further indicated that self-efficacy for psychological well-being serves as a core and bridge factor influencing health-promoting lifestyles among young and middle-aged adults with metabolic risk factors.

Self-efficacy, knowledge, social support, and depression are crucial factors for predicting health-promoting lifestyles in young and middle-aged adults with metabolic risk factors. Moreover, self-efficacy for psychological well-being is the key component that need to be prioritized when developing intervention programs to promote meaningful lifestyle changes.

The online version contains supplementary material available at 10.1186/s12889-025-25192-9.