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.

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.