# A Theory-Based Approach to Predict Stress Relaxation Behavior Among South Asian Americans: A Cross-Sectional Study

## TL;DR

This study explores how stress relaxation behaviors can be predicted and supported among South Asian Americans using a behavioral theory model to improve mental and physical health outcomes.

## Contribution

The study applies the Multi-Theory Model (MTM) to predict stress relaxation behaviors in South Asian Americans, a population with high stress and low mental health service use.

## Key findings

- Behavioral confidence and environmental changes significantly predict the initiation of relaxation behaviors.
- Emotional transformation and social support are key to sustaining relaxation practices.
- The MTM model explained over 69% of the variance in initiating and sustaining relaxation behaviors.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Stress relaxation techniques are crucial for South Asian Americans due to high rates of untreated anxiety, depression, and acculturative stress from immigration and racism, which exacerbate mental health disorders.This work relates to public health by preventing stress-linked physical conditions like hypertension and diabetes, reducing overall disease burden and healthcare utilization in this population.

Stress relaxation techniques are crucial for South Asian Americans due to high rates of untreated anxiety, depression, and acculturative stress from immigration and racism, which exacerbate mental health disorders.

This work relates to public health by preventing stress-linked physical conditions like hypertension and diabetes, reducing overall disease burden and healthcare utilization in this population.

Public health significance—Why is this work of significance to public health?
Addressing stress relaxation and mental health is significant for South Asian Americans, as cultural stigma and underutilization of services lead to widespread unaddressed emotional distress and mood disorders affecting 1 in 5 individuals.This work holds public health significance by promoting health equity, mitigating the links between chronic stress and physical illnesses, and fostering community well-being in a growing demographic prone to misinformation and religious tensions impacting mental health.

Addressing stress relaxation and mental health is significant for South Asian Americans, as cultural stigma and underutilization of services lead to widespread unaddressed emotional distress and mood disorders affecting 1 in 5 individuals.

This work holds public health significance by promoting health equity, mitigating the links between chronic stress and physical illnesses, and fostering community well-being in a growing demographic prone to misinformation and religious tensions impacting mental health.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Key implications include the need for practitioners to develop culturally tailored stress relaxation interventions to overcome barriers like stigma and improve access to mental health services for South Asian Americans.For policymakers and researchers, implications involve funding targeted programs and conducting more studies on severe mental conditions to address data gaps, underreporting, and socioeconomic factors driving disparities in this population.

Key implications include the need for practitioners to develop culturally tailored stress relaxation interventions to overcome barriers like stigma and improve access to mental health services for South Asian Americans.

For policymakers and researchers, implications involve funding targeted programs and conducting more studies on severe mental conditions to address data gaps, underreporting, and socioeconomic factors driving disparities in this population.

South Asian Americans experience multifaceted sociocultural and acculturative stressors that influence mental well-being, yet few studies have applied contemporary behavioral theories to understand relaxation behaviors in this population. This cross-sectional study examined predictors of initiating and sustaining relaxation behaviors using the Multi-Theory Model (MTM) of health behavior change. A web-based survey of 271 South Asian adults incorporated the Perceived Stress Scale (PSS-10), MTM constructs, and sociodemographic characteristics. Reliability was high across MTM subscales (Cronbach’s α = 0.81–0.93). Structural equation modeling demonstrated acceptable fit (CFI > 0.90, TLI > 0.90, RMSEA < 0.08, SRMR < 0.08). Hierarchical regressions revealed that among participants practicing relaxation (n = 202), behavioral confidence significantly predicted initiation (β = 0.481, p < 0.001), followed by participatory dialogue (β = 0.194, p < 0.05) and changes in the physical environment (β = 0.242, p < 0.01). Emotional transformation strongly predicted sustenance (β = 0.395, p < 0.001), along with practice for change (β = 0.307, p < 0.05) and changes in the social environment (β = 0.210, p < 0.05). MTM constructs explained 69.8% of initiation variance and 70.4% of sustenance variance. Among non-practitioners, participatory dialogue predicted initiation (β ≈ 0.18–0.34, p < 0.05), and emotional transformation predicted sustenance (β = 0.570, p < 0.001). These findings underscore MTM’s strong predictive utility and support culturally tailored interventions enhancing confidence, emotional regulation, and social/environmental supports to promote relaxation behaviors in South Asian communities in the United States.