The relationship between social capital, self-efficacy, and health-related quality of life in rural empty-nest older adults with chronic diseases: a latent profile and mediation analysis
TL;DR
The high social capital profile was associated with higher health-related quality of life and self-efficacy than the lower profiles, and profile-informed interventions that enhance self-efficacy in individuals with high social capital and strengthen social capital in those with low or moderate social capital were supported.
Abstract
Background Health-related quality of life is a key indicator of health status among rural empty-nest older adults with chronic diseases, who face limited social resources and a high disease burden. Although social capital is associated with quality of life, its heterogeneity and underlying mechanisms remain unclear. This study aims to identify distinct profiles of social capital using latent profile analysis, examine their effects on health-related quality of life, and test the mediating role of self-efficacy. Methods A total of 425 rural empty-nest older adults with chronic diseases in Ningxia, China were surveyed between April and December 2025 using multistage stratified random sampling method combined with convenience sampling. Data were collected using the social capital scale, the self-efficacy scale, and the EuroQol five-dimension questionnaire (EQ-5D). All statistical analyses were performed using SPSS 27.0 and Mplus 8.3. Results Latent profile analysis identified three social capital profiles: low (29.9%), moderate (49.4%), and high (20.7%). Health-related quality of life and self-efficacy differed significantly across profiles (P < 0.001). In mediation analyses using the low profile as the reference, the indirect effect of self-efficacy was not supported for the moderate profile (SE =0.014, 95% CI =-0.002, 0.053). In contrast, a significant indirect effect was observed for the high profile (SE =0.017, 95% CI =0.028, 0.095), with self-efficacy accounting for 21.2% of the total effect. Conclusion Social capital was heterogeneous among rural empty-nest older adults with chronic diseases. The high social capital profile was associated with higher health-related quality of life and self-efficacy than the lower profiles. Self-efficacy partially mediated this association, whereas no significant indirect effect was found for the moderate profile. These findings support profile-informed interventions that enhance self-efficacy in individuals with high social capital and strengthen social capital in those with low or moderate social capital.