Exploring self-management behaviour clusters and predictors in community-dwelling older adults with declined intrinsic capacity: a cross-sectional study using TPB-HAPA integration.

BACKGROUND: The decline in intrinsic capacity (IC) among older adults poses significant challenges to healthy ageing. Despite the importance of self-management in enhancing IC, research on self-management patterns and their predictors among older adults with declined IC remains limited. PURPOSE: This study aimed to explore clusters of self-management behaviours and their predictors among older adults with declined IC using an integrated theoretical framework combining the Theory of Planned Behaviour (TPB) and the Health Action Process Approach (HAPA). METHODS: This cross-sectional study was conducted in two community health centres in China from December 2022 to June 2023. A convenience sample of 308 older adults with declined intrinsic capacity was recruited based on WHO-recommended criteria. Self-management behaviours were assessed using the Chronic Disease Self-Management Behaviour Scale. HAPA constructs (self-efficacy, outcome expectancy, risk perception, planning) and TPB constructs (subjective norms, behavioural attitudes, perceived behavioural control, behavioural intention) were measured via validated questionnaires refined through expert consultation. Unsupervised k-means clustering was applied to identify behavioural subgroups, validated by principal component analysis. Inter-subgroup differences were examined using Analysis of Variance (ANOVA) or rank-sum tests for continuous variables and chi-square tests for categorical variables. RESULTS: Three distinct self-management behaviour subgroups were identified among older adults with declined intrinsic capacity: Hesitant to Act (n=196), Norm-Dependent (n=42) and Assertive Decisiveness (n=70). Significant differences were observed across subgroups in demographic characteristics, including gender (p=0.017) and education (p=0.005), as well as in HAPA/TPB construct scores, including perceived behavioural control and planning (all p<0.001). CONCLUSIONS: This study identifies three distinct patterns of self-management behaviours among older adults with declined IC. The findings highlight the need for tailored interventions targeting the specific challenges faced by each subgroup. Future research should validate these findings in larger samples and explore causal relationships between variables.