# From Passive to Active—Improving the Healthy Self-Help Behavior of Older Adults Through Community Health Association: Mixed Methods Study

## TL;DR

A new community-based health education model improved older adults' active health behaviors and knowledge in Shanghai, China.

## Contribution

The study introduces a community health association model that combines professional guidance and peer support to sustainably improve health behaviors in older adults.

## Key findings

- Participants showed significant improvement in healthy self-help behaviors and eHealth literacy over 12 months.
- The model increased older adults' willingness to manage health and enhanced social engagement.
- Professional-led education was seen as more authoritative, while peer-led activities were more interactive and flexible.

## Abstract

While China’s aging population and strained health care resources heighten the need for effective health promotion, traditional community health education faces barriers such as passive participation among older adults, short-term behavioral changes, and limited sustainability.

This study aims to develop and examine the impact of an innovative community healthy self-help education model for older adults on healthy behavior and active health awareness among older people.

A mixed methods study was conducted to enroll older participants, including a 12-month pre-post self-controlled trial in 5 communities in Shanghai, China. Health behaviors, autonomy, and eHealth 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 analyzed using repeated measures ANOVA. Semistructured interviews were conducted after the intervention, focusing on the dimensions of willingness to manage health, behavioral transformation, social role change, and attend experiences. The themes were extracted through thematic analysis. Qualitative data served to interpret and enrich quantitative findings.

A total of 80 community-based older people were included in our study, with a mean age of 68.9 (SD 2.2) years. Intervention participants significantly improved in healthy self-help behavior (F3,237=25.43, P<.001). The total mean score improved from 85.90 (SD 22.74) baseline to 107.46 (SD 16.09) 12 months post intervention. Sustained enhancements occurred in health promotion lifestyle (F3,237=76.41, P<.001), health practices ability (F3,237=31.82, P<.001), participation and autonomy (F3,237=5.11, P=.004), and eHealth literacy (F3,237=26.75, P=.002). At the end of the intervention, 11 participants attended semistructured interviews. After the intervention, older people demonstrated stronger willingness and proactive behavior in health management, with increased health knowledge and social engagement. Compared to self-directed activities, health care professional–led education was perceived as more authoritative, whereas peer-organized activities were more interactive and flexible.

The community health association education model based on a community healthy self-help education model for older adults significantly enhanced older adults’ healthy self-management behavior, active health awareness, and eHealth literacy. Integrating professional support with peer empowerment 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 health care system pressures and advancing active aging.