Health self-management ability and its associated factors among community- dwelling older adults in urban China: a cross-sectional study

Background In the context of active aging, this study aimed to assess health self-management ability and its associated factors among community-dwelling older adults in urban China and to inform personalized interventions. Methods In November 2024, participants were recruited from urban communities in Xuzhou, Jiangsu Province, China, using a multistage stratified cluster random sampling method. Data were collected using the self-designed General Information Questionnaire (GIS), the Adult Health Self-Management Skills Rating Scale (AHSMSRS), the Activities of Daily Living (ADL) scale, and the eHealth Literacy Scale (eHEALS). Descriptive statistics, univariate analyses, multivariable logistic regression, and a random forest model were used to analyze the data. Results A total of 1,005 community-dwelling older adults in urban areas were surveyed. Of these, 368 (36.6%) had low-to-moderate health self-management ability, whereas 637 (63.4%) had high health self-management ability. The mean total score was 159.72 (SD, 21.24), corresponding to a standardized score of 84.06. After standardization, the highest and lowest subscale scores were observed for health self-management cognition (87.61) and health self-management environment (80.90), respectively. Across dimensions, self-efficacy had the highest score (88.12), whereas exercise self-management had the lowest score (77.00). Multivariable logistic regression analysis showed that gender, marital status, ADL, life satisfaction, awareness of digital health services, and eHealth literacy were significant factors associated with health self-management ability among older adults ( P  < 0.05). The random forest model ranked these factors in order of importance as follows: ADL, eHealth literacy, life satisfaction, awareness of digital health services, marital status, and gender. Conclusions Health self-management ability among community-dwelling older adults in urban China was generally at a moderately high level. However, relatively low scores were observed for exercise self-management and the use of public health resources, indicating room for further improvement. Particular attention should be paid to older adults with impaired ADL, inadequate eHealth literacy, dissatisfaction with life, limited awareness of digital health services, those who were unmarried, and men. Personalized interventions should be developed from psychosocial, demographic, and digital health perspectives to improve health self-management and the ability to obtain health information among older adults, thereby helping address population aging, respond to changing health needs, and promote active aging. Trial registration Clinical trial number: not applicable