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Purpose <p>Social adaptability is essential for healthy aging. This study examines how Contracted Family Doctor Services (CFDS) affect social adaptability in rural Chinese middle-aged and older adults, assessing the mediating role of regular health management (RHM).</p> Methods and materials <p>Using national cross-sectional data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), we analyzed 13,895 community-dwelling adults. We employed generalized linear models (GLM), mediation analysis, and an instrumental variable-based control function approach (IV-CFA) to evaluate causality and control for confounding.</p> Results <p>Research demonstrated that CFDS participation was significantly associated with enhanced social adaptability (<i>β</i> = 0.204, <i>p</i> &lt; 0.01). RHM partially mediated this relationship, explaining 29.5% of the total effect. Heterogeneity analyses indicated significant associations between CFDS and social adaptability for adults aged 45-60 years (<i>β</i> = 0.250, <i>p</i> &lt; 0.01) and males (<i>β</i> = 0.308, <i>p</i> &lt; 0.01), whereas no significant effects were observed among adults ≥60 years or females.</p> Conclusions <p>CFDS significantly enhances social adaptability among rural middle-aged and older adults, broadening primary care's impact beyond biomedical domains. RHM mediates 29.5% of this effect. The benefits were particularly pronounced among younger individuals and male subgroups. To sustain CFDS effectiveness, China should maintain 1-3% annual coverage growth while implementing targeted measures: combating social isolation in older adults, screening for perimenopausal comorbidities among women, and strengthening intergenerational care support programs.</p>

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The impact of contracted family doctor services on social adaptability among middle-aged and older adults in rural China: the mediating role of regular health management

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月6日

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  • Fan Yang,
  • Min Su,
  • Tianjiao Zhang,
  • Weile Zhang,
  • Zelin Liu,
  • Huibo Li

摘要

Purpose

Social adaptability is essential for healthy aging. This study examines how Contracted Family Doctor Services (CFDS) affect social adaptability in rural Chinese middle-aged and older adults, assessing the mediating role of regular health management (RHM).

Methods and materials

Using national cross-sectional data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), we analyzed 13,895 community-dwelling adults. We employed generalized linear models (GLM), mediation analysis, and an instrumental variable-based control function approach (IV-CFA) to evaluate causality and control for confounding.

Results

Research demonstrated that CFDS participation was significantly associated with enhanced social adaptability (β = 0.204, p < 0.01). RHM partially mediated this relationship, explaining 29.5% of the total effect. Heterogeneity analyses indicated significant associations between CFDS and social adaptability for adults aged 45-60 years (β = 0.250, p < 0.01) and males (β = 0.308, p < 0.01), whereas no significant effects were observed among adults ≥60 years or females.

Conclusions

CFDS significantly enhances social adaptability among rural middle-aged and older adults, broadening primary care's impact beyond biomedical domains. RHM mediates 29.5% of this effect. The benefits were particularly pronounced among younger individuals and male subgroups. To sustain CFDS effectiveness, China should maintain 1-3% annual coverage growth while implementing targeted measures: combating social isolation in older adults, screening for perimenopausal comorbidities among women, and strengthening intergenerational care support programs.